Free elective module information

The elective period comprises 12 weeks of the trainee intern year during which students have a free choice of activity - medical, paramedical or medico-social. The entire elective may be taken in one field of study or may be divided into two consecutive six-week electives in one quarter.  Shorter electives are not encouraged. Your elective period is 12 weeks – not 9, 10 or 11.   We allow a few days for travel.   You may wish to do it all in one place, or break it e.g.   2 x 6 weeks, or 4 + 8 weeks, or 3 x 4 weeks.

The free elective module is intended to encourage experience outside the Otago province, whether within New Zealand or overseas.  The choice of elective requires prospective approval (see later).  Flexibility within the course is possible e.g. if students choose a 12 week medicine or surgery elective they may then be able to undertake an alternative attachment for the 6 week medicine or surgery ward attachment.  This choice must be established at the beginning of the year and must have the approval of the convenor of the module, and the relevant Head of Department.  If you wish to discuss this further please make an appointment to see Professor Rob Walker.

• Selection
• Electives Database
• Objectives
• Assessment
• Elective Report
• Supervisor's Assessment
• Locations
  • NZ Non-Teaching Hospitals
  • Dunedin Based Electives 2010-2011
  • Overseas Electives
• Vacations
• Some Elective Destinations and Contacts
  • The TEN Team
• Where to go, What to do
• Arranging Your Elective
• Guidelines for Medical Students Going Overseas on Electives
  • Travel Clinic at Student Health Services
  • What are the risks?
  • Why have guidelines?
  • Relative risks of tropical travel in a tourist (based on WHO data)
  • 3 months prior to the elective
  • 8 weeks prior to your departure
  • 8 weeks prior to departure
  • The travel consultation(s) (as per MOH)
  • 4-8 weeks before departure
  • Travel First Aid Kit
  • 2-4 weeks before departure
  • During the Elective
  • After the Elective
  • References
• Travel Plans (Very Important Note)
• Insurance Cover for Enrolled Students While Overseas
  • Travel Insurance
  • Professional Indemnity
  • Contacts
• Elective Review Session
• Forms

Selection

The selection of an elective is the responsibility of the individual student, but advice and information can be obtained from many staff members and from the present Trainee Interns.  The Medical Library has on file (under year) previous Trainee Intern elective reports and also information regarding some overseas electives and these may be helpful in choosing an elective.  You can also search for elective reports via the Electives Database –

Electives database

The Electives Database website is merely a search engine and once you have found what you are looking for, you will physically need to go to the Medical Library and look up the respective elective report.

You should discuss elective plans with your proposed supervisor, and also with Professor Rob Walker, who will give final approval.  In all cases, a letter of acceptance from the Supervisor along with information as to the nature of the proposed elective, together with your elective protocol form must be submitted for written approval to Professor Rob Walker (see Appendix A, or download it from Blackboard).  Arrangements should be completed as early as possible and AT LEAST THREE MONTHS BEFORE YOUR ELECTIVE QUARTER BEGINS.  Please ensure Professor Walker’s Secretary has a copy of your elective protocol, and an address where you may be contacted.

Objectives

• To allow you to extend and consolidate knowledge in areas of interest or weakness.
• To provide you with an opportunity to explore in depth some aspect of a chosen topic.
• To encourage you to think about your future and to provide opportunity for contact with possible future vocational areas.
• To allow some of you to round off your training by study of a topic not directly related to future vocation.
• To encourage initiative and a sense of responsibility with minimal direction.

Assessment

The elective period is a prescribed part of the medical course and evidence of a satisfactory performance is an essential requirement before the Board of Examiners approves graduation.  Your elective assessment has two principal components.

Elective report

At the conclusion of your elective you are required to submit a report outlining your elective experience (See Jan Kettink for reporting requirements).   The report should be typewritten, in electronic format and should include any projects undertaken or especially interesting clinical or other aspects of the attachment.  Your comments and the value of your particular elective and any recommendations to those undertaking electives in the future are welcomed.  You are advised to write this report during the last two weeks of your elective attachment.  Excuses for lateness WILL NOT BE ACCEPTED and your report must be in the hands of Jan, together with all your supervisor's assessments, by the following dates.

In the case of those students taking electives in the final quarter you should ensure that Professor Walker receives your report one week before completion of your elective, i.e. by Friday 11 November 2011 at the latest.  Your qualification depends on the submission of a satisfactory elective report.  This report must reflect your three month elective experiences.  A three to five page brief synopsis is not acceptable. If you wish to view your supervisor's assessment form please contact Jan.

Supervisor's assessment

Your supervisor will be requested to report on your elective.  When you arrange your elective you should make it plain that this is a prescribed part of your University course and as such there must be a nominated supervisor who will be agreeable to provide a brief written report on you.  Before the end of your elective you must give your assessment form  (Appendix C) to your supervisor (in person) who should either post/fax it to Jan, or return it to you so that it can be handed in with your elective report.

In the event of either an unsatisfactory elective report or supervisor's assessment the student will be required to present for an elective assessment viva with the electives sub-committee which will consider whether he/she has completed the prescription for the course.  This will include students in the fourth quarter who may be required to return to Dunedin specifically for this purpose.

Locations

New Zealand non-teaching hospitals

A wide variety of excellent clinical experience is available for those willing to work hard and accept responsibility for patient care.  Most smaller hospitals in both the North and South Islands have had students over recent years.  Your approach should initially be to the Medical Superintendent of your chosen hospital giving some indication of your interests, e.g. medicine, surgery, paediatrics, etc.  When you accept an elective at one of these hospitals you should note that it will not be satisfactory for you to be rostered on a number of different specialties for very short periods.  The contact people for the main centres are:

You may very reasonably be asked to undertake some service work during your time at peripheral hospitals, but your experience is unlikely to be enhanced by standing in as Acting House Surgeon for a week or 10 days duration on four or five runs while the local House Surgeon takes his holidays.  As a general rule, runs of less than six weeks duration will not be acceptable.

Dunedin-based electives 2010 – 2011

If you are considering undertaking your elective in Dunedin or Southland, please refer your enquiry directly to the Trainee Intern Course Coordinator who holds the master timetable and therefore able to advise if any of the disciplines listed below could potentially be available. All Dunedin or Southland based electives MUST be arranged through the Office of the Trainee Intern Course Co-ordinator in Student Affairs, NOT with the Department or Consultant concerned.

Overseas electives

Students who feel able, both physically and financially, to spend their elective periods overseas are encouraged to do so.  Some electives are arranged through the Health Department or other agencies, but others may be available by personal negotiation with the overseas location of your choice.  Advice can be given to any students wishing to travel overseas but uncertain of contact addresses. Please note that students are NOT to undertake unsupervised surgical procedures and if in doubt should contact Professor Rob Walker IMMEDIATELY.

Vacations

First quarter has a 2 week vacation period in the middle however,  you can take this at any time during your elective quarter.   The choice is yours.   There is also a 2 week vacation between third and fourth quarter and if your elective is in either of these quarters you can take this vacation time when you like also.

Some elective destinations and contacts

The Electives Network in partnership with Medical Assurance Society
Everything you need to know to plan your elective

The Electives Network Ltd. (TEN) is a non profit company founded by Dr Gordon Hamilton in 2001 whilst a pre-clinical medical student at Oxford University. The primary goal of TEN was to provide medical students with a comprehensive planning tool, one which would provide up to date information as well as a forum for dynamic student interaction.

We have expanded the TEN databases to its current size of 5,000+ hospitals in over 120 countries worldwide. We deliver this content via a professionally designed and maintained Content Management System CMS which together with a continuous stream of student feedback reports results in a self updating website interface.

Since our establishment in the UK and Ireland, and our launch in Australia in 2005, followed by New Zealand recently, we have been aided by major sponsors, the Medical Defence Union (UK and Eire), MDA National (Australia) and Medical Assurance (NZ) to intensely target the medical student population in these countries. For example, in the UK, between 20-30% of the student elective market will access the TEN site each week, with a similar percentage using the Australian site.  We are also extremely encouraged by the positive response to us by the New Zealand medical elective students so soon after the launch and we also continue to have a massive number of medical students requesting access from countries where we are yet to provide our services.

With the launches of the mirror TEN site in Australia and New Zealand and plans to shortly expand into parts of Western Europe, we are achieving our long-term strategic goal of being 'the leading electives planning resource for medical students around the world'.

If you need help with planning your elective you can access TEN through the Medical Assurance Society website.  Simply go to www.medicals.co.nz , click on ‘ Electives Login’, then enter your Membership number and password.  If you don’t have a password or are not a Member, please call on 0800 800 MAS (627) and they will set one up for you.

However if you have returned from your elective your feedback really does benefit those students who want to follow in your footsteps so we ask that you go to the electives feedback section and complete the form which should take no more than 5 minutes to fill in all the fields.

Whether your elective is ahead or behind you we send you all our very best wishes for many exciting times in the future.

The TEN Team, and the Medical Assurance Society

• IFMSA – NZMSA is now a member of IFMSA (International Federation of Medical Students’ Association), but not for the purpose of organising an elective.  Students from the University of Otago, Schools of Medicine are unable to apply for a placement through this organization.
• Perth, Western Australia
  • Web: http://www.medicine.uwa.edu.au
• Kings College, London
  • Web: http://www.kcl.ac.uk/schools/medicine/ugstudy/electives/visitingexchanges/
• Karolinksa, Stockholm, Sweden
  • Web: http://info.ki.se/education/ects/Medicine/medicine_intro_en.html
• Royal Cornwall Hospitals (NHS)
  • Email: med.education@rcht.swest.nhs.uk
• Glasgow, Scotland - Sheila Le Vin
  • Email: smlv1h@clinmed.gla.ac.uk  
• Fiji School of Medicine - Dr Waine Baravilala, Dean
  • Email: w.baravilala@fsm.ac.fj
• Royal Darwin Hospital, P O Box 41326m Casuarina NT, 0811
  • Email: mandi.cook@flinders.edu.au
  • Tel: 08 89 228 888
  • Fax: 08 89 228 286
• Alice Springs Hospital, PO Box 2234, Alice Springs NT 0871
  • Email: anita.rogers@nt.gov.au
• Tel: 08 89 517 777
• Fax: 08 89 517 665
• Katherine & Gove Hospitals, North. Terr.,
  • Tel: 08 89 467 079
  • Fax:  08 89 467 077
• Tennant Creek Hospital
  • Email: Andrea.Postrak@nt.gov.au
• Sri Lanka - Dr Asoka Thenabadu
  • Web: www.medicalelectives2srilanka.com
• Central Australian Student Placements
  Northern Territory General Practice Education Ltd
  • Carita Davis - Program Coordinator
  • Email: carita.davis@ntgpe.org
  • Web: www.ntgpe.org
  • Tel: (08) 8950 4805
  • Fax: (08) 8952 3536
  • This is the contact for the rural GP program that they have.  It goes to remote centres all around Alice Springs.  The first week is an orientation to aboriginal health but to go there as an elective you have to be able to coordinate your start with the start of one of the orientation programs.
  • The Australasian Society of Clinical Immunology and Allergy (ASCIA) offers annual educational grants to medical students in Australia or New Zealand during their elective term, engaged in activities related to Clinical Immunology and/or Allergy.
  • This grant is an initiative of the local organising committee of the 2000 World Allergy Congress (WAC)*, which was held in Sydney.  These annual grants are awarded from the proceeds of this meeting.
  • WAC was previously known as the International Congress of Allergology & Clinical Immunology.
  • The application form can be downloaded from the ASCIA Website.
• Kiwisstat is Australasia’s largest medical recruitment company committed to the placements of locum and permanent doctors into placements across Australasia.  We are extremely concerned about the plight of rural and small town hospitals across Australasia and for this reason we are offering scholarships for sixth year medical students to help pay for elective placements in these areas.    We offer $500 subsidies for medical students towards their rural elective placement.  One per clinical school.  Once a student has been selected we will liaise with the hospital an department to confirm the elective.  We will assist with organising travel and accommodation.  We aim to put New Zealand and Australian medical students into positions in rural hospitals across Australasia.  For further information, please contact Dr Miriam Martin - Website.
• Labasa Divisional Hospital, Fiji
  • Elective Attachment in Paediatrics and Child Health. A tertiary level hospital including facilities such as NICU, observation nursery, children ward, isolation, A&E, OPD, recovery ward & C/S.  Accommodation: Residential hotel chef available, 3-5 minutes walk from hospital.
  • Contact:  Md. Abdul Mannan
    MBBS DCH MPhil PhD
    Acting Consultant of Paediatrics, Labasa Divisional Hospital
    P.O. Box: 577, Labasa, Fiji.
  • Email: madr_2@yahoo.com

Where to go, what to do

You will really want to go somewhere e.g.  Nepal,  India,  UK,  the Australian Outback,  the Pacific Islands,  work with an Aid Agency,  Greymouth and the West Coast.  You could be keen for a particular specialty in a large teaching hospital (ie Paediatrics at a Children’s hospital);   or you may be interested in research and want to do a nonclinical elective.   Remember also,  people have had some exciting and interesting electives in New Zealand. 

Arranging your elective

Once you have decided where you want to go and what you want to do, you contact the Hospital or Service.   If you are unsure, please discuss with Professor Rob Walker, or some of the hospital staff.     Some of the larger Hospitals/Universities have application forms on their web sites.     You would generally write to the Convenor of Electives if it is a large hospital, or the person in charge of a Service. When you write asking for an elective, tell them the exact dates you are wanting a placement and if appropriate, a choice of one or two specialties. Tell them that this is a formal part of your final year and must be supervised and reported upon.  You might like to send a brief CV with your initial letter.

Enquire about tuition / administration fees / any other special requirements –eg immunisation,  specific insurance cover as well as medical indemnity.  Also enquire about accommodation – ask if hospital accommodation is available,  recommendation/suggestions of other places where elective students stay and approximate  cost. Staying in hospital or recommended accommodation is a good way of meeting other medical students.

Some places will send you back a formal application form to complete, and some also require a letter stating you are a bona fide student of the school.  Student Affairs Office can provide you with this letter of recommendation.

Canada (and some other places) require you to have a medical examination, chest x-ray, hepatitis screening,  etc.  You must contact the Canadian Embassy in Sydney for details about this and allow plenty of time for the processing of this.

Be prepared to write to several places to get what you want.   Some places (one being the Pacific Islands) are not quick to reply and you may need to phone them after a few weeks to check that they have received your correspondence and ask if it is OK for you to go there.  Ask for confirmation in writing, make and keep copies of all correspondence (especially emails) with your host hospital – this is most important to attach to your Elective Protocol for signing off by Professor Walker, and you may also need to produce it for visa or immigration purposes, or on arrival at the hospital.

Guidelines for medical students going overseas on electives

Going overseas on a medical elective is an exciting opportunity and there is good evidence of educational benefit(1,2). However, travelling outside the relatively supervised environment of the medical school to a situation where you may be expected to perform clinical tasks unaided carries some vulnerability to occupational risks. The local clinical setting in developing countries may be in an area with high HIV prevalence, the worksite may for a variety of reasons have poor infection control practices, and students may be exposed to HIV and other blood borne viruses(3). In addition, tropical travel is associated with possible exposure to tropical infections and other environmental risks.

Please make an appointment at Student Health Services to discuss your travel, at least 8 weeks before you intend leaving.

Travel clinic at Student Health Services

• Contact Student Health Services (03 479 8212) to make a travel clinic appointment.  Please tell the receptionist that you are a medical elective and we will try and accommodate your travel appointment around lectures etc.
• Initial appointment will be booked with a nurse for 30 minutes, then appointments with a doctor will be organised based on travel requirements.
• For travel to higher risk destinations, you will require a minimum of 3 subsequent appointments for vaccinations over at least a one month period.
• Travel clinic appointment costs $50.00, exclusive of vaccination costs.  The $50.00 covers all appointments required for the elective travel.  Vaccination costs range from $0 - $1,000 each + $6.50 nurse visit (cash or eftpos only).

What are the risks?

In a questionnaire study on Tasmanian students returning from medical electives, 64% had experienced some form of health problem while overseas(4), while a few developed serious infections (including leptospirosis and paratyphoid) and several students reported assault or sexual harassment. Similarly, a group of medical students on elective from Glasgow, Scotland(5) reported a 45% rate of ill-health while overseas, of which 77% was gastrointestinal. With regard to the risk of blood borne viral disease, a study reported in BMJ by a medical student and two virologists in 1999(6) using a questionnaire in students after an elective overseas, suggests that accidental percutaneous or mucosal exposure to potentially infected body fluids had occurred sometime during their training in 44% of a group of UK medical students, but the majority (75%) had not reported this. Of the 220 students, four had been exposed to possible blood borne viral disease during their electives and three of these students were in areas of high endemicity for HIV. This risk is not just in medical students: a group of Dutch doctors working in Africa have reported that 61% had percutaneous exposure during an average 21 months stay, and there was an estimated occupational HIV infection risk of 0.11% per annum(7). Due to relative inexperience, students may be more clinically vulnerable(8).

Why have guidelines?

A number of medical schools internationally have considered that there is a duty of care to advise medical students going on clinical electives overseas even though ultimately the degree of personal risk is something that a student has to weigh up for themselves(9). Some destinations may be considered too high risk (a current example would be Zimbabwe because of political unrest) while some may be very low risk and require minimal pre-travel health preparation, such as most Australian electives. However, for electives in tropical countries or HIV-endemic areas or if there are considered to be other significant environmental risks, adequate pre-travel preventive health care and advice is recommended. Although risk is part of life some risks can be reduced by awareness and appropriate preventive measures including but not restricted to vaccinations and malarial chemoprophylaxis. In addition some risks, such as possible HIV or rabies exposure, need to be managed by secondary prevention using post-exposure prophylaxis (PEP).

Table 1: Relative risks of tropical travel in a tourist (based on WHO data)

Suggested guidelines for management of health-related risks for overseas clinical electives:

At least 3 months prior to the elective

• Select a suitable elective destination by checking the experience of previous students, and discussing the proposed elective with the elective convenor.
  
  
• Do your own research on the health risks using reputable resources such as local advice from the host organisation or health professional, WHO website(10) CDC website(11) , Ministry of Foreign Affairs and Trade (NZ)(12) or the Foreign and Commonwealth office (UK) website(13) and maybe Lonely Planet or similar. You should attempt to contact a local doctor through e-mail or via phone to inquire about endemic infections and availability of resources.  Note that travellers may be different from the locals in terms of their susceptibility to local infections (e.g. malaria), and in some cases, the clinical manifestations (e.g. dengue fever among travellers vs. dengue haemorrhagic fever among the locals).

At least 8 weeks prior to your departure

• Make an appointment with a GP who has some knowledge and expertise in travel medicine. In general, GPs with a special interest in this area will have the PG certificate or diploma in Travel Medicine or similar or will be members of a travel medicine organisation such as the International Society of Travel Medicine (ISTM) or Travel Medicine and Vaccination Clinics (TMVC) or Medical Advisory Service for Travellers Abroad (MASTA) (see websites of these organisation for up to date lists) However, some GPs have experience in this area without formal qualifications.
  
  
• Identify whether the country is an area of high HIV endemicity(14). You can access this information via the WHO website or if you are unsure check with Professor Walker. Note that the accepted area of endemicity i.e. sub-Saharan Africa, is no longer the only risk area and there is an increasing prevalence  of HIV in areas of SE Asia, the Indian sub-continent, the Caribbean and Central and South America (see figure 1). You may also need to consider HIV PEP if you will be working in an area of higher than average HIV endemicity (e.g. hospice care in some countries). If so you will need to arrange to meet with Professor Walker to discuss HIV PEP, whether to take a kit from the Dunedin School of Medicine (DSM) and how and when to use it.  There are 2 HIV kits here that students can "borrow" but they must put it on their insurance as each kit costs $2,000!!!
  
  
• The majority of body fluid exposures are low risk as regards HIV transmission.  The risk is considered significant when one gets stabbed by a needle with visible blood (e.g. during surgery) or by a hollow needle that has just been withdrawn from a blood vessel (e.g. during venipuncture or central line insertion).  HIV is a friable virus and does not survive well outside the human body in the absence of special culture media.  Mucous membrane exposures are low risk unless there is a break in the mucous membrane and the patient has a high viral titre.
  
  
• Post-exposure prophylaxis (PEP) should be commenced as early as possible after a significant exposure.  Prophylaxis requires 100% adherence, otherwise resistance can develop if transmission occurred.  Side effects from anti-retrovirals are common but almost always improve with time and with fluids and analgesics.  These include easy fatigue, headache, nausea or feeling “hung-over”.  The current recommendation is to continue PEP for at least 4 weeks or until it has been ascertained with a PCR test that no transmission occurred during the exposure.  If one is in an area with limited resources, it is advisable to head back to New Zealand where HIV resources and support are available.
  
  
• The other scenario where HIV transmission can occur is through blood transfusion after a road traffic collision.  There remains HIV transmission through blood in poor countries where HIV is endemic.  This is where haemacell will come in handy.  It is important that a local person is aware who they need to contact to arrange emergency air evacuation in case you are unable to make those arrangements (e.g. traumatic brain injury).
  
  
• Assess whether you will be working in a tuberculosis endemic area (see WHO website or get advice from Travel Doctor.   If so, it is advisable to do a 2 step Mantoux test before travel and 3 months after your return to assess whether there has been Mantoux conversion and a need for treatment for latent Tb.
  
  
• Consider (through discussion with travel health advisor, senior medical students, maybe group time with fellow students going on elective or the Elective Convenor) what should be the limitation of your clinical exposure during your elective. It will be much easier for you to say “No” if you are asked to do something that you feel is unsafe or outside your clinical competence if you have already considered your safe limits.
  
  Figure 2: Current HIV endemicity as of 2003 (WHO Global Atlas of infectious diseases)

8 weeks prior to departure

• When you visit your GP, take a copy of your vaccination records including routine vaccines as per NZ immunisation schedule such as Hepatitis B, measles mumps rubella (MMR), Tetanus–diphtheria (Td) and polio. If you have had any previous travel vaccine take information re when and what you have had (e.g. Hepatitis A, typhoid, rabies, JBE, TBE, etc). You may need to boost routine vaccines such as polio and MMR.

You will need a longer than average consultation to discuss the travel issues in the table below. Your first appointment will be with a nurse and this will cost $50 which covers Doctors visits also.  This will be to discuss your itinerary, the date you leave Dunedin and New Zealand and which countries you will be visiting.    We will discuss previous travel and childhood vaccinations. If there are any vaccines we think you may need and you are unsure if you have had these, we can organise blood tests.

We will then book you into an appointment with a Travel Specialist Doctor.  Vaccine costs are additional.

The Travel Clinic appointments are primarily Tuesday mornings but we will do our best to accommodate you as we can.

Table 2: The travel consultation(s) (as per MOH)

About 4-8 weeks before departure

• Arrange the best travel insurance that you can afford. Preferably this should include emergency air evacuation, willingness to courier essential medications to you (such as rabies PEP) and an emergency helpline to an English speaking medical advisor that requires minimal local currency. Make sure that your insurer is happy to cover you on a student elective since some policies will only cover normal tourist risks.
• Have a dental check up before you leave home (you do not want to have treatment in some parts of Africa or SE Asia).
• Consider purchasing and taking with you an IV giving set, a mosquito net and permethrin soaking solution, disposable gloves, maybe some haemocel if your suitcase will hold it, syringes and needles. These can be purchased from a surgical supply store/some travel medicine clinics ( MASTA).
• Discuss your personal first aid kit with your home GP or SHS. Some items you can purchase yourself and some will require a prescription. This could include:

Table 3: Travel first aid kit

About 2-4 weeks before departure

• Photocopy all important documents and leave a copy with a reliable person at home, carry a second copy in a separate place to your travel documents
  
  
• Know the address and phone number of the NZ consulate in the area that you will be travelling to.
  
  
• Know who your emergency contact person is in DSM or SHS or your host organisation re discussing HIV PEP in confidence to assist you in the situation where you have to decide whether or not to use it. (It may be advisable to have 2 contact people in case one is unavailable). Also know who your support person is in the host organisation for assistance with culture shock, ill-health and similar issues.

During the elective

• Consult a doctor if you are unwell during the elective, especially if you are feverish. Any fever 7 days or more after entering a malarial area could be malaria or another tropical “nasty” and rapid diagnosis is essential.

After the elective

• Consult a doctor if you are unwell or have health concerns any time up to a year after the elective, especially if you are feverish, and tell the doctor that you have travelled overseas on a medical elective. Malaria can present up to a year after exposure although falciparum is unusual >6 months. Other tropical diseases such as dengue, typhoid and paratyphoid, schistosomiasis etc may also become symptomatic after travel.
  
  
• Do a 3 month post exposure Mantoux test if you have been in a Tb endemic area.

References

1. Imperato PJ. A third world international health elective for U.S. medical students: the 25-year experience of the State University of New York, Downstate Medical Center. Journal of Community Health. 29(5):337-73, 2004 Oct.
2. Harth SC. Leonard NA. Fitzgerald SM. Thong YH. The educational value of clinical electives. Medical Education. 24(4):344-53, 1990 Jul.
3. Franklin GF. Gray K. Nathwani D. Provision of drugs for post-exposure prophylaxis of HIV for medical students on overseas electives. Journal of Infection. 43(3):191-4, 2001 Oct.
4. Goldsmid JM. Bettiol SS. Sharples N. A preliminary study on travel health issues of medical students undertaking electives. Journal of Travel Medicine. 10(3):160-3, 2003 May-Jun.
5. Cossar JH. Allardice GM. Whiting B. Health surveillance of Glasgow medical undergraduates pursuing elective studies abroad (1992-1998).  Journal of Travel Medicine. 7(6):314-8, 2000 Nov-Dec.
6. Gamester CF. Tilzey AJ. Banatvala JE. Medical students' risk of infection with bloodborne viruses at home and abroad: questionnaire survey. BMJ. 318(7177):158-60, 1999 Jan 16.
7. de Graaf R. Houweling H. van Zessen G. Occupational risk of HIV infection among western health care professionals posted in AIDS endemic areas. AIDS Care. 10(4):441-52, 1998 Aug.
8. Cervini P. Bell C. Brief report: Needlestick injury and inadequate post-exposure practice in medical students. Journal of General Internal Medicine. Vol. 20(5)(pp 419-421), 2005
9. Moss PJ. Beeching NJ. Provision of health advice for UK medical students planning to travel overseas for their elective study period: Questionnaire survey. British Medical Journal. Vol. 318(7177)(pp 161-162), 1999.
10. http://www.who.int/ith/en/
11. http://www.cdc.gov/travel/
12. http://www.mfat.govt.nz/travel/
13. http://www.fco.gov.uk/en/travel-and-living-abroad/

Travel plans (very important note)

If you are taking a first quarter elective, you must ensure that you do not book your travel to commence until AFTER the unofficial results of the fifth year examinations have been advised to you, usually by email from the Student Affairs Office, approximately ten days after the fifth year final examinations.    If by chance you fail these examinations, you will NOT be allowed to undertake your elective, as you will not be a sixth year medical student.  Therefore, booking travel to commence before this date, is at your own risk.   We strongly advise against paying for travel before the unofficial results come out.   The official results will follow from the University at a later date.   If you fail, you will be required to meet with the Associate Dean and discuss the special examinations and/or any remedial work/Terms requirements.  The specials examinations are usually held around the end of January each year. If you pass these, you will be permitted to commence the sixth year course at the start of the second quarter (i.e. around the end of February), and you will then complete your degree twelve months later, subject to a successful pass in all of the attachments/modules. 

If taking a fourth quarter elective, officially you are required to be back in Dunedin for the last week.  However, if you have made contact with all the module conveners, prior to leaving Dunedin to check that you have met all the requirements for the award of Terms in all disciplines, and are not required for a pass/fail/distinction viva  in the last week of the quarter, then this is not necessary.  However, you must ensure that your elective report and supervisor’s assessment has been returned to Professor Rob Walker, ONE WEEK BEFORE the end of the quarter. Your graduation is dependent upon this. 

You cannot leave for an elective attachment, until your elective protocol has been seen and signed off by Professor Walker, at least three months before the elective is due to be undertaken. 

The last week of the sixth year course is when the pass/fail /distinction vivas are held across the three schools, and there is also a prize-giving and complimentary (free) graduation and farewell dinner held on the Thursday night (17 November 2011).  This function is to award the local School prizes and is a social function hosted by the Dean and staff of the Dunedin School of Medicine, and the Southern District Health Board, to congratulate and farewell our new graduates.  This is your last chance to get together with your colleagues and consultants before you depart into the big wide world of employment so please put this date into your social calendar now.

Insurance cover for enrolled students while overseas

Travel insurance

It is strongly recommended that travel insurance is purchased.  This insurance typically provides cover for:

• Medical expenses
• Costs of evacuation due to medical problem(s)
• Flight cancellation costs
• Personal effects

In addition, some policies provide Personal Liability cover, which meets costs resulting from accidental injury to third parties and damage to their property.

The University's insurance broker, Marsh, has arranged a comprehensive policy (the "Studentsafe-Offshore Policy" insured by Vero), which provides this cover at a competitive price.  If you wish to find out more about this policy, please see below for contact details.  Other insurance companies offer similar packages, but it is important that you make sure that any insurance you purchase covers the areas listed above.

Professional indemnity

Professional Indemnity insurance provides cover for claims by third parties for breach of professional duty by reason of negligence, error or omission.  The University's professional Indemnity policy covers students as long as they are under the direct supervision or control of the University, however as there is no such direct supervision or control while a student is overseas, this cover is effectively limited to New Zealand.  For this reason, the University requires that all trainee interns join the Medical Protection Society (MPS), which provides worldwide indemnity to its members.

Conclusion

Students intending to travel on overseas elective should be aware:

• Travel insurance is strongly recommended.
• The University's professional indemnity insurance does not cover students outside New Zealand.
• Membership of the Medical Protection Society is compulsory.

Contacts

• MPS (Medical Protection Society)      
  Tel: 0800 22 55 677
• Visit the website www.studentassist.co.nz for an online quote and purchase of Studentsafe-Offshore.
• Call the Vero Student Helpdesk:  0800 486 004 for further assistance.
  OR
• Mr Ken Albrecht at Marsh, Phone:  04 819 2439 for further information about the Studentsafe-Offshore Policy.
• The extras included in the StudentSafe Policy which will not be found in any other policies, and is specific to elective students, is the needlestick cover for the accidental puncture from a medical hypodermic needle.
• A very important fundamental is students belong to the very large student insurance pool which we manage, so any difficult claim will land at Marsh and we use our influence and technical expertise. Not the sort of back up they might get from a travel agent...

Definition of public liability is the common usage for describing certain events that are insured where a person is involved.  Because it deals with damage to the public and property not your own.

The OFFSHORE policy uses Personal LIABILITY to describe the same risk you will note the subsets 1 2 3 which define the elements of the cover.

The heading could use "Public" or "Personal", according to our technical person.

The University will not approve electives in war zones, areas of high terrorist activity, or areas with health issues (eg SARS).

Very important

It is your responsibility to check what your host hospital/country needs by way of personal insurance/public liability cover as well as the above.   Some places in Australia are now asking for proof of insurance for personal injury and public liability (if you have injury to yourself or an accident in regards to property and assets).   The University of Otago strongly advises you to get in touch with the following person for travel and health insurance when on elective as they have designed a policy specifically for this purpose.  The policy is called the Student-Safe-University Pack and details and application forms are available from the following person:

• Mr Ken Albrecht at Marsh 04 474 1170

If you are really keen to go to some of the third world countries you need to check on the HIV situation and find out if the hospital has procedures in place for accessing appropriate antiretroviral therapy etc.   These things must be sorted out BEFORE you commit to an elective attachment.   Please remember that Professor Walker has the final signing off of any elective arrangements.   The SARS outbreak affected elective plans, and when things like this happen, the University (on advice from WHO) has the final say if you can go to these areas or not, also check the Ministry of Foreign Affairs website for information on travel advice: http://www.mfat.govt.nz/travel/index.html    Please check with Professor Walker about visiting these places.

Medical Protection Society (MPS)

MPS provides indemnity cover for medical students during their final year, and this cover extends to electives.   You must contact them and provide them with information about your elective e.g. where you are going and the dates.   They may also require specific information in case of any changes in cover due to SARS, terrorism etc.

It is a prerequisite for all Trainee Interns to have Medical Indemnity cover. The University currently recommends joining the Medical Protection Society (phone:  0800 22 55 677.  There is no subscription for this cover until the House Surgeon year. This protection covers indemnity insurance while you are on your elective and protection is worldwide including Canada and the USA.  If medical protection is not taken out, this would be a breach of agreement with the District Health Board and hence Trainee Interns could be personally liable if they were involved in any litigation proceedings.

When Trainee Interns are heading off on elective, MPS are happy to provide a certificate;  however there are certain steps you need to take before this can happen and they are as follows:

You MUST contact MPS on 0800 225 5677 or email mps@medicals.co.nz

• Advising what country you are going to
• Dates of elective
• Up to date address and phone numbers

If students are heading over to Australia there is a different procedure and that is why it is important that MPS are contacted first.  Once MPS has your elective information they will then send the appropriate documentation to you.

Overseas professional indemnity confirmation for Australia
Your MPS student membership will provide you with the benefits of membership whilst in Australia as long as the criteria below is met:

• All electives should be organised either by you or the Dean of your University
• All electives must be authorised by the Dean
• All work must be under the supervision of a fully qualified medical practitioner
• All work must not exceed the level of your own qualifications or competence

Following changes in Australian medical legislation in July 2003, MPS administrative arrangements for electives in Australia are slightly different to those elsewhere in the world.   In brief, this new legislation stipulates that every health care practitioner in Australia, including students, must be covered by an insurance policy.  As MPS is not an insurance company they have made arrangements with Medical Indemnity Protection Society (MIPS) based in Victoria to cover your elective whilst in Australia. The MIPS Student Members Master Policy is underwritten by the Australian insurance company, Health Practitioners Australia Pty Ltd. (HPIA), which is wholly owned by MIPS.

You will remain a member of MPS and there will be no additional subscription to pay
The only action you need to do is log onto www.mips.com.au click the student icon and complete the online application form.  Ensure that in the field titled "Please enter any message you wish to send here" you provide full details of the intended elective including location, hospitals involved, name of supervisor, nature of your work and the start and end dates of your elective period.

Remember to include your MPS membership number
Once your application has been approved MIPS will issue you with an insurance certificate and policy documents for the duration of your elective.

Private international and government sponsored students
If international students decide not to go home for their elective, but choose to go elsewhere in the world, with their sponsor’s permission, then they must go to the International Office and get a “top up” of their insurance (additional Student Safe Policy) and provide them with a copy of their elective protocol, indicating where they are going, and the dates they will be away.

MAAP - Medical Aid Abroad Programme
MAAP is just beginning in Otago. It was established in Auckland in 2006 and it is planned to establish it at all three Otago University clinical schools during 2007. The aim is to identify sister hospitals who are in need of resources and are willing to take on TI students during their elective.  Once a good relationship has been established the hospital gives MAAP a wish list consisting of the resources that they need and the TI takes items from this list to the hospital when they are on their elective.  We hope that this will be a process where we work in partnership with the hospitals and contribute to sustainable improvements.  If you have any questions, suggestions, information, or relevant contacts you can  email  MAAP at maap.nz@gmail.com

Guidelines for pandemics, infectious disease exposure, political unrest or any "threat" to personal safety
While on electives, students may find themselves caught in unexpected situations, for example – a pandemic, an infectious disease exposure, political unrest or threat to personal safety.  In the event of such a situation,  your safety is the priority of the Dunedin School of Medicine (DSM).   It is the expectation of the Dunedin School of Medicine that you conclude your elective and return to New Zealand.   Please liaise at the earliest opportunity with Professor Rob Walker, Trainee Intern Convenor, through his secretary (Jan), or the Trainee Intern Course Coordinator.  

Upon your return to Dunedin please contact the Trainee Intern Course Coordinator to discuss alternative arrangements for your elective.   Please note that you will not be penalised for not meeting “terms” in the event of unexpected situations that are a risk to your safety.

Elective review session

An informal 20-minute interview for information sharing with members of the Trainee Intern Committee will be arranged within six weeks of the end of your elective quarter.  The Dean of the Dunedin School of Medicine convenes this meeting and any Trainee Intern unable to attend on the day selected should contact Jan for an alternative date with a subsequent group.  The review session will not normally be part of any assessment procedure.

Forms

The following forms must be completed:

• Appendix A: Elective Protocol (pdf)
• Appendix B: Trainee Intern Elective Reports (pdf)
• Appendix C: Final Year Student Elective Assessment (pdf)
• Appendix D: Declaration Concerning Medical Elective Report (pdf)