Intended for healthcare professionals

Opinion BMJ Student

The high cost of opportunity: how medical school electives deepen the class divide

BMJ 2024; 385 doi: (Published 18 June 2024) Cite this as: BMJ 2024;385:q1344
  1. Ritu Bhattacharyya, fifth year medical student
  1. UK

UK medical schools should ensure that elective placements are accessible and affordable for all students

Who were medical school electives created for? As a student who is estranged from my family and in receipt of my university’s bursary for low income students, I don’t think that it’s for students like me. UK medical schools have introduced widening participation initiatives to try to admit more students from diverse socioeconomic backgrounds. Yet we’re still playing catch-up in the way the course is run.12 One prime example of this is the elective placement.

At my medical school the elective is a six week experience. For some of my fellow students, the world is their oyster. They can choose from their international travel bucket list of where they’d like to go and what specialties they’d like to experience. In comparison, my first thought was, “How am I going to afford this?”

Prices from one elective provider, Work the World, start at £22903—and that’s excluding flights, vaccinations, travel insurance, visas, and indemnity insurance. Many electives based in the UK also have hidden costs. Administration fees, alongside the cost of travel and accommodation, can make even the seemingly more affordable electives that are closer to home inaccessible. For example, the University of Edinburgh charges a matriculation fee of £400.4 Elective bursaries are available, but demand far outstrips supply, meaning that many students who need the financial assistance often miss out.

Medical schools often don’t provide advice on the affordability of electives. This silence from medical schools seems to stem from the assumption that all students will be in a financial position that allows them to spend thousands of pounds on an international elective. This couldn’t be further from my experience. I completed my elective in the city where I attend medical school, gaining the position by emailing several consultants in the hope that one would reply and agree to be my elective supervisor, free of charge. Arranging this within the timeframe set by my medical school, with no guarantee that I could find a doctor to agree to supervise me, was isolating and stressful.

A privilege for the few

The Medical Schools Council states that an elective placement “provides the opportunity to develop new skills, increase awareness of social and cultural issues, and be exposed to different healthcare settings.”5 Medical students can gain many life skills from an elective abroad: going to a completely new environment and living a totally different life for a few weeks can do wonders for your confidence and can open your eyes to different cultures or perspectives.

Should these lessons not be afforded to students from all backgrounds, rather than just the more privileged among us? The class divide deepens when you see colleagues from higher income backgrounds completing their electives in sunny tourist spots, travelling and having fun, while other students complete a 9-5 in their local NHS trust.

Elective placements aren’t the only time when students from widening participation backgrounds are poorly supported during their medical degree. The many other hidden costs of being a medical student create a class divide that financial assistance schemes and university grants never quite bridge. Even the NHS bursary has been deemed insufficient by the BMA’s Medical Students Committee.6 The typical student will see their maintenance loan cut in half when they enter their final year and become funded by the NHS bursary.2789 It’s often the students at this stage of their training who are expected to plan expensive electives—precisely when they’re in their most precarious financial position.

I’m not calling for overseas electives to be scrapped, but universities do have a duty to ensure that medical degrees are accessible and affordable for all students who undertake them, and this includes the experience of electives. Levelling the playing field could take many forms: grants for travel and accommodation, partnerships with local hospitals and consultants who already work with the medical school, or collaborating with medical schools abroad through student exchange programmes. These small steps by universities could make a huge difference for students like me.


  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.