The international medical elective in Nepal: perspectives from local patients, host physicians and visiting students

Objectives: To understand the impact of the international medical elective (IME) on Nepali patients and physicians alongside visiting European and American medical students. Methods: At a hospital in Nepal, semi-structured interviews were conducted with 15 patients and 15 physicians about positive and negative experiences with visiting medical students. Likert scale surveys about knowledge of Nepal, clinical competencies, and post-elective feedback were administered to 56 visiting medical students before and after their elective. Interviews were coded using conventional content analysis and surveys were analyzed using descriptive statistics and paired t-tests. Results: Emergent positive themes from interviews were that visiting students enhanced the reputation of the hospital, afforded financial benefits, improved international collaboration, and increased knowledge, culture and language exchange. However, negative themes were the language barrier and time expended to orient students. Before vs. after the elective, visiting students had increased knowledge of Nepal's healthcare system (M=1.9, SD=0.6 vs. M=3.2, SD=0.6, t((55))=10.22, p<.001), ability to communicate with health professionals from different backgrounds (M=3.3, SD=0.7 vs. M=3.6, SD=0.7, t((55))=-3.11, p=0.003) and practice in resource constrained environments (M=2.4, SD=0.9 vs. M=2.8, SD=0.9, t((55)))=-2.42, p=0.02). However, students had no change in history (M=4.0, SD=0.7 vs. M=3.9, SD=0.7, t((55)))=0.84, p=0.40), physical exam (M=3.9, SD=0.6 vs. M=3.9, SD= 0.7, t((55)))=0.22, p=0.82) or diagnostic (M=3.5, SD=0.7 vs. M=3.4, SD=0.8, t((55)))=1.52, p=0.14) abilities. Conclusions: This study demonstrated a variety of benefits and harms of the IME. To improve the IME experience, medical educators should emphasize pre-departure orientation and fostering equitable partnerships between sending and receiving institutions.