BACKGROUND Most international electives in which medical students from high-income countries travel abroad are largely unstructured, and can lead to problematic outcomes for students as well as sending and receiving institutions. We analyse the problems of unstructured medical electives and describe the benefits of an elective experience that includes more organisation and oversight from the sending medical school. RESULTS A number of structured elective programmes have been developed, including those at the Medical School for International Health, Israel and the University of Dundee, United Kingdom. These programmes provide significant pre-departure training in global health and the ethical dimensions of electives, support and monitoring during the elective, and post-elective debrief. Crucially, the programmes themselves are developed on the basis of long-term engagement between institutions, and have an element of reciprocity. We further identify two major problems in current medical electives: the different ethical contexts in which electives take place, and the problem of 'voluntourism', in which the primary beneficiary of the activity is the medical student, rather than the receiving institution or health system. These two issues should be seen in the light of unequal relations between sending and receiving institutions, which largely mirror unequal relations between the Global North and South. CONCLUSION We argue that more structured elective programmes could form a useful corrective to some of the problems identified with medical electives. We recommend that medical schools in countries such as the UK strongly consider developing these types of programmes, and if this is not possible, they should seek to further develop their pre-departure training curricula.

中文翻译：

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结构化的医学选修课：一个时代已经到来的概念？

背景技术大多数来自高收入国家的医学生出国旅行的国际选修课基本上是没有组织的，并且可能导致学生以及发送和接收机构的结果出现问题。我们分析了非结构化医学选修课的问题，并描述了选修经历的好处，其中包括派遣医学院校进行更多的组织和监督。结果已经开发了许多结构化的选修课程，包括以色列国际卫生医学院和英国邓迪大学的课程。这些计划在全球健康和选民的道德层面上提供重要的出发前培训，在选修和选修后的汇报中提供支持和监控。至关重要的是 这些计划本身是在机构之间长期合作的基础上制定的，并具有互惠性。我们进一步确定了当前医学选修课的两个主要问题：选修课在不同的道德背景下进行，以及“志愿服务”问题，其中活动的主要受益者是医学生，而不是接受医疗机构或卫生系统。应该从发送和接收机构之间的不平等关系看待这两个问题，这在很大程度上反映了全球北方和南方之间的不平等关系。结论我们认为，结构化的选修课程可以对医学选修课识别出的一些问题做出有用的纠正。