The International Summer Elective Program (ISEP) at a Saudi Public Medical School: Student Views and Lessons Learned

Received: 16-Aug-2022, Manuscript No. IJMRHS-22-72043; Editor assigned: 18-Aug-2022, Pre QC No. IJMRHS-22-72043; Reviewed: 01-Sep-2022, QC No. IJMRHS-22-7204; Revised: 17-Jan-2023, Manuscript No. IJMRHS-22-72043; Published: 24-Jan-2023

Introduction

Many medical colleges initiate international health electives as part of their curricula, whether during the preclinical phase or the clinical phase to strengthen their student's knowledge and enhance their communication skills [1]. The General Medical Council (GMC) defines an elective as 'a period of clinical experience that the student chooses and is often taken outside the UK,' allowing them to form their learning experience [2].

In addition to the formal medical knowledge learning process, international health electives play a role in preparing students to face different public health challenges and provide them with new cultural perspectives, making their future career goals more transparent and defined [3].

A fair number of medical students from developed countries prefer to have their summer electives in a foreign country to be exposed to various regional outbreaks or country specific disease cases, even though some ethical difficulties and different health risk issues may arise in some developing nations [4].

Students who take an field foreign health elective have the opportunity to develop their resumes uniquely, solidifying their research skills and their connection network by establishing multi aspect projects about certain medical cases that tend to occur in developing or rural areas of the elective country, as well as providing medical care to low resource populations under different health care systems which are not what they used to be like in their home country [5,6].

The international health electives could be applied to different fields, such as the pharmaceutical field, clinical practice elective and research based electives; this could give us a sense of the importance of the health electives for the undergraduate medical students in different health care fields to enable them to excel in their future career academically and clinically while discovering new cultures.

The Liaison Committee on Medical Education (LCME) states that accreditation standards affirm that the medical school curriculum should include elective courses to supplement the required courses and provide opportunities for students to pursue individual academic interests. International health electives can support different aspects of the medical school curriculum [7,8].

The Imam Mohammad Ibn Saud Islamic University (IMSIU) School of medicine had a summer elective program that provides students with multiple experiences to practice their clinical and research knowledge in many medical fields; this research aims to evaluate the influence of our international health electives on medical students who enrolled in our programs by either positive or negative results and their overall experience [9].

Materials and Methods

Study design: This is a cross sectional study using a self-administered anonymous questionnaire to assess students’ perceptions of their experience of the International Summer Elective Program (ISEP).

Study instrument: After obtaining the author’s permission for use and modification, the questionnaire was adapted from a previous study carried out at King Saud university, school of medicine, after obtaining the author’s permission for use and modification. The questionnaire was also subjected to pilot tests to assure its validity before starting the study. The questionnaire consists of 19 items divided into three parts; the first part is about demographics and the second part consists of 13 questions on a five point Likert scale to assess the experience and perceptions of the medical students at Imam Mohammad Ibn Saud Islamic university school of medicine and the last part was devoted to the suggestions and recommendations. The students were informed about the purpose of the study; instructions concerning questionnaires were provided to volunteer students and the confidentiality of information was also ensured. Once the students voluntarily signed their informed consent, they were asked to fill out the study questionnaires. All students were emailed to participate and were reminded via email and an SMS web link.

Research participants: The questionnaire survey was sent in February 2019 to a total of 60 students who had taken part in the (ISEP) in the summer of 2017 and participated during the electives to the end of it. Selection criteria were based on multiple points (academic performance, extracurricular activities and curriculum vitae) and reminders were sent to them every three days. The participants were contacted by their emails and contact information provided by the college's student affairs. Students who were enrolled but did not travel for any different reason were excluded from the study, as well as incomplete responses. Of a total of 60 students, the complete responses were 44 respondents (73%), 12 (27.3%) were from the first year and six respondents (13.3%) from the fourth year, as represented in tables.

Data analysis: Data analysis was carried out with a chi square test of independence variables employing the SPSS program. This test allows the researcher to gauge whether there is a relationship between two categorical variables of interest. When interpreting the chi square independence test, adjusted standardized means can serve as helpful guidelines to pinpoint what categories are most influential, that is, where is the most significant deviation from the expected average?

Ethical approval: The study was carried out after approval from the IMSIU IRB committee project number 75-2019 session number 27, dated 17 November 2019. The study follows the guidelines of the declaration of Helsinki.

Results

Table 1 shows the demographics of the participants and their distribution into different categories, which are gender, academic year, times of elective experience, countries of elective travelled and the number of publications at the time of survey. The most significant number of the study sample was selected after their second year with a percent equal to 34.1% followed by the first year with a percent equal to 27.3%, then the third year with a percent equal to 25% and the fourth year with a percent equal to 13.6%. In comparison, 65.9% of the study sample individuals were selected one time for a summer international health elective and 34.1% of the study sample individuals were selected twice for the summer international health elective. The majority of students travelled abroad to the United Kingdom for their elective with a percentage of 40.9%, followed by the United States of America and the United Kingdom with a percentage of 25%, which is equal to the percentage of Spain, then followed by the United States of America alone with a percentage of 2%. Furthermore, the percentage of students who recommend continuing the ISEP program (those who said yes) was 75% with a frequency of 33 (Table 2).

Table 1: The demographics of the participants.

Table 2: Perceptions of students in the International Summer Elective Program (ISEP).

Regarding the student's perception of the International Summer Elective Program (ISEP), Table 2 demonstrates their levels of agreement by a five point Likert scale from strongly disagree to strongly agree in thirteen different statements of their experience regarding the elective with the statistical significance for each statement.

Individuals in the study sample who are students in the medical school show that students' perceptions contribute to the need for the International Summer Elective Program (ISEP). The mean of all phrases is 3.40, with a standard deviation of 0.56. This mean lies in the third category of the five scales, which indicates that most of the study sample individual agrees and the results are as follows.

The phrase "the quality of logistics in your (ISEP) (language barriers, food chain availability, accommodation preparations and transportation etc.) was good" shows that the student agrees with the quality of logistics with a mean value of 4.05 (p<0.001) and the phrase ‘your overall experience of the country of your elective was satisfactory (not the ISEP program itself)’ was ranked first with a mean value of 4.05 out of 5 (p<0.05), which shows that the student agreed that the country of participation had a strong effect on them.

The phrase "the ISEP program gave you the opportunity to be aware of different cultures" was ranked second with a mean value of 3.98 out of 5 (p<0.001), showing that students agreed that the elective gave them the opportunity to be aware of different cultures.

The phrase "You had adequate supervision during (ISEP) program” was ranked third with a mean value of 3.70 out of 5 (p<0.001), which shows that the students agreed that the elective gave them a chance to be aware of different cultures.

The phrase "You feel you have become more advanced in research skills in comparison with your other colleagues after the (ISEP) program." has a mean value of 3.66 out of 5, which was not statistically significant.

Table 3 summarizes the student's recommendations about continuing the International Summer Elective Program (ISEP) with multiple written responses from students.

Table 3: Recommendations of the study sample individuals to continue the ISEP program.

75% of the study sample individuals recommend continuing the ISEP program in their college.

Recommendations regarding the (ISEP) program: The International Summer Elective Program (ISEP) should be held every year to help students aware of a different culture.

The International Summer Elective Program (ISEP) orientation sessions should be periodically for students and should be organized more often with advanced tools such as online registration for elective selection to improve accessibility.

The ISEP program should be promoted more prominently and offered to students at a later stage of their academic year, that is, fourth and fifth years. The number of slots for students should be increased to allow more students to benefit from the program.

More countries should participate in the International Summer Elective Program (ISEP) to increase the number of students who will benefit from the program. It encourages students to participate in the ISEP program to improve their experience.

Qualitative analysis of the study: Few students freely respond about their experiences and the few responses are as follows.

A: It would be better if publication were a mandatory point from the hosting institute.
B: A continuous support and supervision from our college are significant for a good outcome to be observed; because it was almost non-existent after the program.
C: It was an honour and pleasure to be part of this program and college; it was an excellent experience that I will remember and it was helpful. I would recommend that they focus more on conducting good research.
D: Personal improvement exceeds research skills benefits.

Discussion

International health electives demonstrated different ways in which students can develop their skills, whether in research or preparing their clinical skills in other countries while interacting with vulnerable communities or among cultural differences, encouraging them to expand their awareness on how they can deal with more compassion and empathy. However, establishing a framework of health electives like three stages of "Pre departure planning and briefing, in country experiences and returning from the elective evaluation" promotes a promising role in ensuring that medical students are "safe, healthy” during their elective work and 'do no harm when facing ethical issues when dealing with things beyond their clinical scope of training. Furthermore, to prepare students before their elective, it is essential to review the academic records and their professional history of the applicants, as well as past extracurricular activities. Additionally, students willing to take their electives in developing countries must obtain medical evacuation insurance with specific prophylaxis such as HIV and antimalarial drugs for their safety measures [10].

Even if the student's response is still valuable, other studies highlight the critical aspect of the host's experience with elective programs. Medical students may face ethical and moral dilemmas because geographical settings are not very familiar; as shown in our results, 22 students (50%) agree that they had adequate supervision during their ISEP program (P-value<0.05) [11,12]. In contrast, our students strongly agree (36.4%) and agree (36.4%) to have a satisfactory experience in countries in which their elective was conducted (P-value <0.05).

Health electives also influence students' career choices in the future and provide hindsight guidance to their decision, especially toward public health practice or physician scientist, while also raising the interpersonal skills, Improvement of resourcefulness and cost effectiveness of the student's perspective manners. However, maximum benefits could be earned if pre, intra and post elective training programs were applied to students to have fixed guidelines of health electives for the upcoming challenges and minimize the negative points such as health and safety risks [13].

Moreover, with the growth of global health importance, many US institutions and organizations emphasize programs to improve the outcome of the state of health among individuals in the United States and around the world [14].

Training medical students is one of the leading ways to obtain different experiences in the medical field. Training programs should be under the supervision of institutions that guide the training process [15].

Regarding career choices, only two students (4.5%) strongly agree that and 7 (15.9%) agree they are aware of future career choices (p-value<0.05). Furthermore, it showed that surgical electives played a vital role in developing medical students' ethical and surgical interests in their future careers [16].

Most of the medical students who have taken international health electives in our college were satisfied with the overall experience of global health electives (P<0.05), and many of our student participants, 33 (75%), had recommended continuing (ISEP) program in our college. Furthermore, compared to the analysis of the elective curriculum in undergraduate medical education in a Croatian study, it was suggested that the majority of students decided to take the elective most self-preferred for them 611 (73.3%) if they have the opportunity to do so [17].

Another study indicated that all students (100%) out of (8) responses strongly agreed that the elective course increased their awareness of pharmacists' need on medical outreach teams and would recommend this elective course to other students. It is an opportunity to gain specific skills, knowledge and even confidence regarding the health care system [18].

Conclusion

Furthermore, our students reported that they gained relevant research skills from their elective (P<0.05). The value and benefit of this study are to shed some light on how student exposure to different challenges in various cultures could provide them with an additional source of learning, which will enable them to apply problem solving strategies and ideas that they have adopted from outside their home country into their daily or future academic and nonacademic life.

Furthermore, we recommend that other national medical colleges consider initiating international health electives for their students.

Limitations

Students’ experience was evaluated two years after their elective program was conducted, which can cause recall bias. The country of elective may have a role to play in students' perception as a whole and it should be considered as well as the number of electives encountered for each individual.

Acknowledgment

We would like to thank all the participants who put their work into the study and the facultymembers, Prof. Mona M. Soliman, MBBS, MSc., Ph.D., for permitting us to use their validated questionnaire.

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