WMA Statement on Ethical Considerations in Global Medical Electives

Adopted by the 67th  General Assembly of the World Medical Association, Taipei, Taiwan, October 2016

PREAMBLE

• Medical trainees are increasingly participating in global educational and service experiences, commonly referred to as ‘international medical electives’ (IMEs). These experiences are normally short term, i.e., less than 12 months, and are often undertaken in resource-limited settings in low-and middle-income countries.

• Although IMEs can provide valuable learning experience, this must be weighed against the potential risks to the host community, the sponsor organization and the visiting trainee. Successful placements help to ensure that there are mutual benefits for all parties and are built upon an agreed understanding of concepts including non-maleficence and justice.

• Published ethical guidelines, such as the Ethics and Best Practice Guidelines for Training Experiences in Global Health by the Working Group on Ethics Guidelines for Global Health Training (WEIGHT), call on sponsor institutions (i.e., universities and organizations facilitating electives) to commit to sustainable partnerships with host institutions and local communities. All parties are also called upon to work collaboratively in creating professional guidelines and standards for medical electives.

• In turn, trainees undertaking IMEs must adhere to relevant ethical principles outlined in WMA ethical documents, including the WMA’s Declaration of Geneva, the WMA International Code of Medical Ethics and the WMA Statement on the Professional and Ethical Use of Social Media.

RECOMMENDATIONS

Therefore the WMA recommends that:

1. Sponsor institutions work closely with host institutions and local communities to create professional and ethical guidelines on best practices for international medical electives. Both institutions should be actively engaged in guideline development. The sponsor organization should evaluate the proposed elective using such standards prior to approval.
2. Guidelines should be appropriate to local context and endorse the development of sustainable, mutually-beneficial and just partnerships between institutions and the patients and the local community, with their health as the first consideration. These must take account of best practice guidelines, already available in many countries.
3. Guidelines must hold patient and community safety as paramount, and outline processes to ensure informed consent, patient confidentiality, privacy, and continuity of care as outlined in the WMA International Code of Medical Ethics.
4. Guidelines should also outline processes to protect the safety and health of the trainee, and highlight the obligations of the sponsor and host institutions to ensure adequate supervision of the trainee at all times.  Institutions should consider means of addressing possible natural disasters, political instability, and exposure to disease.  Emergency care should be available.
5. Sponsor and host institutions have a responsibility to ensure that IMEs are well planned, including, at a minimum, appropriate pre-departure briefings, which should include training in culture and language competency and explicit avoidance of any activity which could be exploitative, provision of language services as required, and sufficient introduction and guidance at the host institution. Post-departure debriefing should be planned on return of the trainee, including reviewing ethical situations encountered and providing appropriate emotional and medical support needed.
6. It is expected that the trainee will receive feedback and assessment for the experience so that he/she can receive academic credit. The trainee should have the opportunity to evaluate the quality and utility of the experience.
7. Trainees must be fully informed of their responsibility to follow instructions given by local supervisors, and to treat local host staff and patients with respect.
8. These guidelines and processes should be reviewed and updated on a regular basis as sponsor and host institutions develop more experience with one another.
9. National Medical Associations should develop best practices for international medical electives, and encourage their adoption as standards by national or regional accrediting bodies, as feasible, and their implementation by sponsor and host institutions.