Medical students' risk of infection with bloodborne viruses at home and abroad: questionnaire survey

The articles in the January 16th BMJ1,2,3 placed the onus on medical
schools to reduce the health risks of medical students choosing to
undertake electives in HIV prevalent countries. There was little
discussion, however, of ways medical students should be helping themselves
in these situations. Evidence that 27 of 65 medical students who visited
areas with a high prevalence of HIV infection were unaware of this1,
points to a wider failure on medical students= to prepare, observe and
reflect throughout their placement experience.

Before departure valuable information is available from many sources
including newspapers, books about the region, journals, and travel health
clinics. People with experience in the developing world, such as academic
staff and people working for Non Governmental Organisations, are also
approachable. The appropriate resources exist but students need to invest
a degree of personal interest to find them.

Once on elective, risk of injury (to students and patients) is
naturally higher if students work in unsafe work environments, without
appropriate supervision and with clinical freedom they may not have at
home. This risk surely multiplies again if medical students have not
considered the scenarios in which they may find themselves, nor grappled
with the moral, ethical and practical issues surrounding these scenarios.
The medical student working in an HIV prevalent area, who considered all
the implications of performing invasive procedures on patients who may be
vulnerable through lack of education, is likely to make a better decision
about engaging in potentially hazardous situations.

In this light, recommendations for medical schools to produce
infection control guidelines and to make appropriate pre-elective health
advice available to medical students, addresses only part of the problem.
Medical students are capable of helping themselves to reduce their risk of
infection on elective, and medical schools should encourage and facilitate
this process. Seminars given by people with health care experience in
developing countries would be valuable, as would incentives (e.g. essay
competitions, elective grants) for students to consider and document their
clinical experiences in the context of socio-economic, family and cultural
influences. Participation in Asafe@ elective projects in high-risk
regions could also be encouraged, such as community-based studies, and
programs for health worker training, health education and health
promotion.

Above all else, more medical students need to devote a greater
proportion of their thoughts to their electives.

Joshua White
4th year medical student, Monash University, Melbourne
50 Williams Rd
Windsor
VIC 3181
AUSTRALIA

In 1998 I undertook placements for 5 months in hospitals and
communities in KwaZulu-Natal, South Africa.

1 Gamester CF, Tilzey AJ,Banatvala JE. Medical students= risk of
infection with bloodborne viruses at home and abroad: questionnaire
survey. BMJ 1999;318:158-160.

2 Moss PJ, Beeching NJ. Provision of health advice for UK medical
students planning to travel overseas for their elective study period:
questionnaire survey. BMJ 1999;318:161-162.

3 Wilkinson D, Symon B. Medical students, their electives, and HIV
(editorial). BMJ 1999;318:139-140.

EDITOR - We agree that risk of blood-borne viral infection to medical
students undertaking their electives in areas with a high prevalence of
these diseases is an important issue.

Dr. Oommen (correspondence) makes a valid point that there is
considerable literature available on disease prevalence. However, this
becomes irrelevant if students are not accessing this information as
Gamester et al.1 have shown. Their results demonstrate a lack of
awareness of such information amongst students and their advisors at the
medical school studied.

Thus, we acknowledge that the authors have clearly identified an area
of concern. However, the generalised conclusion they make may not be
applicable to all medical schools. We therefore suggest a prospective
multi-centre study. By providing a questionnaire to students at several
medical schools prior to their elective, one might further increase the
awareness of such risks whilst also improving the scope and accuracy of
this paper.

Finally, whilst the article's title suggests a study encompassing
risks both at home and abroad, the majority of their findings relate to
risks encountered overseas. The title might therefore mislead the reader.

Yours sincerely,

Nadine McAloney,
Jonathan S. Murray,
Andrew S. McQueen,
Raed Al-Roughani,
David C.G.Sainsbury.

3rd Year Medical Students,
Department of Epidemiology and Public Health
University of Newcastle-upon-Tyne

1Gamester CF, Tilzey AJ, Banatvala JE. Medical students' risk of
infection with blood-borne viruses at home and abroad. BMJ. 1999; 318: 158
-160