Table 2.

Recommendations for implementation by medical student elective program coordinators

Issue	Recommendation	Reference
Responsibilities	Determine those issues that are the responsibility of the Medical School and distinguish from those that are the responsibilities of students. Inform students of their responsibilities (Table 3).	[3, 24, 27, 42, 49]
	Consider creating a detailed webpage for the program, to be kept up-to-date and embedded with an institutional site.	[15, 16]
	Assess all elective applications on the basis of personal risk and educational merit.	[27, 49]
	Develop a range of enduring elective destinations including the establishment of strong and mutually beneficial partnerships with international organizations, universities and health care providers.	[1, 85]
	Site visits to host institutions to provide quality assurance in academic standards and ethics, based on context and partnership agreements	[1, 22, 73]
General Policies	Provide students with policies on electives, including choices of destination country and clinical experiences.	[32, 41, 49]
	Provide students with guidelines on health and safety on electives.	[21, 27, 32, 41]
	Inform students of medical indemnity, public liability and personal protection insurance provisions for electives.	[27]
	Policies should be created in collaboration with host institutions, particularly where formal partnerships are being forged	[24]
	Policies need to be implemented and a degree of compliance achieved by both elective program coordinators and students.	[85]
Travel advisories	Consider elective destinations in the light of national travel advisories and be prepared to deal with unexpected changes in risk status.	[24, 32]
	Ensure that students travelling to higher-risk destinations have sought pre-travel health advice and have purchased travel insurance.	[5, 21, 32, 49]
	Instruct students to register with institutional travel registries.	[33, 34]
	Provide students with 24-h faculty contact for urgent issues.	[32, 49]
Occupational risk assessment	Consider providing travel doctors with information on occupational risk management in electives.	[32, 41, 49]
	Establish policies on HIV PEP, including supply and funding.	[49]
Pre-departure training programs	Ensure that pre-departure training is provided for students, covering educational outcomes, clinical experiences, ethics and social accountability, occupational risk management, health and safety.	[32, 41, 42, 44, 47, 56, 59, 60, 64, 86]
	Reinforce learning from training modules with pertinent and enlightening reading material from peer-reviewed literature on international medical electives.	[8, 9, 23, 49, 55, 59, 87]
	Ensure that experienced faculty play a central role in planning and implementing training sessions to ensure quality and sustainability.	[32, 47, 60]
	Include procedural skills in pre-departure training.	[38, 88]
Funding and finances	Ensure that students are aware of the approximate costs of electives, including the need to budget for travel insurance and vaccinations.	[41, 59]
	Inform students of bursaries, scholarships and other funding support that may be available.	[49]
	Sending organisations and students should consider funding host institutions to compensate for resources used during the placement and to develop the host institution	[54]
Post-return debriefing and screening	Ensure that students are offered post-elective debriefing sessions. Consider providing travel doctors with information on post-return health screening.	[86]
	Encourage students to reflect on their elective experience through reflective writing, discussion groups or academic debriefing.	[23, 47, 49, 63]
	Seek feedback from host institutions on both individual students and broader programmatic issues.	[9, 49]