WMA Statement on Ethical Considerations in Global Clinical Electives

Adopted by the 67th  General Assembly of the World Medical Association, Taipei, Taiwan, October 2016
and revised by the 76th WMA General Assembly, Porto, Portugal, October 2025

PREAMBLE

Visiting medical students or residents are increasingly participating in global educational and service experiences, commonly referred to as Global Clinical Electives, Global Health Electives or Short Term Global Health Experiences.

Although Global Clinical Electives can provide valuable learning experiences, this must be weighed against the potential risks to the host community, the sponsor organization and the visiting medical student or resident. 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 in keeping the WMA International Code for Medical Ethics.

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) and the Brocher Declaration, 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 clinical electives.

In turn, visiting medical students or residents undertaking Global Clinical Electives must adhere to relevant ethical principles outlined in WMA ethical documents.

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 Global Clinical Electives. Both parties should be actively engaged in guideline development and update. The sponsor organization should evaluate the proposed elective using such standards prior to approval.
2. Sponsor institutions and host institutions should strive to facilitate two-way exchanges.
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 visiting medical students and residents, their scope of practice according and highlight the obligations of the sponsor and host institutions to ensure appropriate supervision of these students and residents at all times. The Scope of Practice of medical students and residents during Global Clinical Electives should be commensurate to their education and should not exceed their scope of practice in their home country.
5. Sponsor and host institutions have a responsibility to ensure that Global Clinical Electives are well planned, including at a minimum: appropriate pre-departure briefings, which should include training in culture and language competency, 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 visiting medical student or resident, including reviewing ethical situations encountered and providing the appropriate emotional and medical support needed.
6. The visiting medical student or resident should receive feedback and assessment of the experience so that academic credit can be received. The visiting medical student or resident should also have the opportunity to evaluate the quality of the experience.
7. Visiting medical students or residents 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. WMA constituent members should support the development of best practices for Global Clinical Electives and encourage their adoption as standards by national or regional accrediting bodies, as feasible, and their implementation by sponsor and host institutions.