More and more students are looking to complete their elective placements abroad, often in low- and middle-income countries (LMICs) such as Uganda and India. However, there has been very little research into the potential benefits, costs and risks associated with such placements. Despite students often paying large amounts of money to private companies, usually very little (if any) of this is used to support the hosting country’s health system. Furthermore, local staff are often expected to provide support and supervision to students despite already being overworked and under resourced. This can lead to poor learning outcomes for students and put them (and patients) at risk.
This research project was initially funded by Health Education England (£250,000) and ran from May 2015 to November 2016, in partnership with the University of Salford. Its objectives were to assess the learning outcomes and risks associated with student elective placements in LMICs and to develop an ethical and sustainable placement model that could mitigate the risks and maximise the positive impacts of such placements.
This action research project followed a mixed methods approach. Two placement sites were selected; one in Fort Portal (Uganda) and one in Bangalore (India). Over 120 students from Nursing, Midwifery, Social Work, Physiotherapy, Occupational Therapy, Podiatry and NHS Management courses were placed across the two sites over an 18-month period, usually for a duration of 4 weeks. Their experiences and learning were assessed using various surveys, focus groups and interviews. Interviews were conducted with local staff, health officials and supervisors in both countries, as well as relevant policy makers and University programme leaders in the UK. We also studied the barriers faced by students wishing to undertake international elective placements and the related ethical considerations. The structures of the placements were continuously updated and refined over the course of the project in line with findings.
The project concluded that student elective placements can be run ethically and sustainably, providing all risks are properly considered and that they are organised for the mutual benefit of all stakeholders. Without such considerations, placements can be very detrimental to the hosting facility and can jeopardise the health and safety of both students and patients. The importance of pre-placement induction sessions for students was highlighted, as well as the critically important role that local staff and/or professional volunteers can play in providing supervision and contributing their knowledge and skills both to the students and the wider health system. A successful model was designed and this now forms the basis of K4C’s ongoing student placement programme, which has since placed over 300 students in Uganda. The evaluation of all K4C student placement activity is ongoing.
Our research findings have been disseminated at several conferences and workshops, as well as forming the basis of two publications which can be accessed (for free) using the links below:
Ahmed, A.; Ackers-Johnson, J. & Ackers, H.L. (2017) “The Ethics of Educational
Healthcare Placements in Low & Middle Income Countries: First Do No Harm?”
Palgrave Macmillan. DOI: 10.1007/978-3-319-48363-4
Ackers, H.L.; Ackers-Johnson, J.; Ahmed, A. & Tate, N (2019) “Optimising Student Learning on International Placements in Low Income Settings; the Contribution of Cultural Brokerage”, Open Journal of Social Sciences, 7 https://doi.org/10.4236/jss.2019.7302