Papers

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

Peter J Moss, honorary clinical lecturer,  Nick J Beeching, senior lecturer. 

Division of Tropical Medicine, Liverpool School of Tropical Medicine, Liverpool L3 5QA

Correspondence to: Dr Beeching NBeeching{at}aol.com

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

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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

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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.

	Acknowledgments

We thank the staff of the medical schools who took the time to complete our questionnaire, and our colleagues Charles Gilks, Fred Nye, Bertie Squire, and Sharon Welby for helpful discussion and comments on the article.

Contributors: Both authors conceived and designed the study and wrote the paper. PJM conducted the telephone enquiries and postal survey.

Funding: None.

Competing interests: None declared.

website extra: Additional information about the questionnaire appears on our website www.bmj.com

	References

Top Methods and results Comment References

1. Gilks CF, Wilkinson D. Reducing the risk of nosocomial HIV infection in British health workers working overseas: the role of post-exposure prophylaxis. BMJ 1998; 316: 1158-1160[Free Full Text].
2. Expert Advisory Group on AIDS. Guidelines on post-exposure prophylaxis for health care workers occupationally exposed to HIV. London: Department of Health , 1997.
3. Ellis C. Post-tropical screening [letter]. BMJ 1993; 307: 1008.
4. UNAIDS. Report on the global HIV/AIDS epidemic. Geneva: UNAIDS, World Health Organisation, 1998:63-64.