Provision of health advice for UK medical students planning to travel overseas for their elective study period: questionnaire survey

An external elective period is included in the curriculum of most medical schools in the United Kingdom. Of this year’s applicants for elective grants at one school, 97% planned to go abroad; 69% of applicants chose developing countries, the most popular destination being southern Africa. Attention has been drawn to the potential health risks facing elective students (J H Cossar et al, fifth international conference on travel medicine, 1995 (abstract 201)) and also to the risk of HIV infection for health workers in developing countries.¹ We conducted a survey to determine how health advice for elective students who plan to travel abroad is provided.

Methods and results

We sent a questionnaire to the 26 medical schools in the United Kingdom after making a telephone call to determine the most appropriate addressee. A telephone reminder was made to those who had not responded after four weeks. Further detail about the questionnaire is on the BMJ’s website.

Twenty two replies (85%) were received (table). Of the medical schools from which no response had been received, two stated at the reminder call that the addressee was on leave and two that the form would be returned soon.

Most medical schools (20) that replied provided some form of travel health advice, usually in the form of a group lecture or seminar. Some distributed written guidance: this ranged from a single paragraph about health in a document covering various elective issues, to a comprehensive 12 page guide to travel and occupational health. Few schools (7) made internal provision for immunisations, and many of those that did not make such provision also had no check on whether students had followed the advice given. Only 2 schools offered routine health screening to elective students on their return.

Almost all the respondents (21) said that students were given advice about HIV infection. In many cases, however, this was as part of the normal curriculum, and academic knowledge concerning HIV infection and AIDS in Britain does not necessarily correlate with an understanding of the personal risks involved in working in the developing world. Most schools had not considered how current guidelines for the management of occupational exposure to HIV could be applied to overseas elective students.²

Comment

The attitude of medical schools towards the occupational health of students going on overseas electives varies considerably. Some schools take a “hands off” attitude: “At the end of the day, they are adults, after all.” Others are far more restrictive, refusing to sanction electives to countries where there are considered to be serious health risks. There should be more consistency in pre-elective preparation for medical students, with standardised written advice produced in collaboration with expert groups. Some schools may not have the facilities to provide individual advice and immunisations but could advise students where these could be obtained. Schools could also provide a checklist for each student, to be signed by the general practitioner or doctor at the travel centre, confirming that appropriate advice had been received and (in the case of immunisation) followed. Health screening after overseas electives is of limited value in preventing illness³ but would provide useful feedback on the efficacy of measures taken before travel: a structured health questionnaire would be adequate in most cases.

The problem of occupational exposure to infection, particularly HIV, is more difficult. One solution, already adopted by at least two schools, is to discourage students strongly from going to areas with a high prevalence of HIV infection. Much of the developing world, however, now has a high prevalence,⁴ and students may therefore be denied a valuable experience. Post-exposure prophylaxis will not be available in many parts of the world, and the expense of providing drugs for students to take with them is likely to be unacceptable. Some institutions have already started to think about the implications for their own students, but widespread consultation does not seem to have taken place. Future practice should be based on a policy decided nationally.

Table.

Responses of 22 medical schools who returned questionnaire

Question	No of respondents answering yes	Comments
Is travel health information provided by medical school or occupational health department?	20	Written information provided by 11 schools  (7 of which sent copies with their returned questionnaires)
Are immunisations arranged by medical school or occupational health department?	7
Does medical school check whether advice and immunisations have been received?	10	No checks were done in 1 school that did not provide advice and in  7 that did not arrange immunisation
Is a health check on return to Britain offered?	2	A further 3 schools provided health check on request
Is information on occupational exposure to HIV given to students?	20	Often as part of normal curriculum
Is information on sexually transmitted diseases (including HIV infection) given to students?	20	Often as part of normal curriculum
Is post-exposure prophylaxis available to students on overseas electives?	2	A further school said that it advised students about post-exposure  prophylaxis; 2 further schools said that they did if the student  was doing an “affiliated centre elective”; a further 3 said “yes, in  certain locations”

Editorial by Wilkinson and p 158