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      Healthy, safe and effective international medical student electives: a systematic review and recommendations for program coordinators

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          Abstract

          Background

          Thousands of medical students undertake international medical electives each year. These students face potentially substantial health and safety risks as well as educational and ethical challenges and therefore should undertake their electives within well-structured and coordinated programs.

          Methods

          We conducted a qualitative systematic review based on a pre-determined protocol. Relevant publications and guidelines relating to international medical electives were identified through a review of the literature using on-line search engines, principally PubMed. We then conducted a systematic qualitative synthesis to extract relevant publications. Finally, the literature was organized according to themes, with the aim of developing a structured set of Recommendations for Implementation for program coordinators.

          Results

          A wide range of important issues were identified which were categorized into seven themes upon which recommendations were made principally for the benefit of program coordinators: Responsibilities; General policies; Travel advisories; Occupational risk assessment; Funding & finances, Pre-departure training programs; and Post-return debriefing and screening.

          Conclusions

          Recommendations for program coordinators on the health and safety of medical students while on international medical electives have been sourced from existing guidelines and relevant publications. There was considerable consensus from the literature and as such these synthesised recommendations could form the basis for internationally accepted standards for elective placement program coordinators.

          Electronic supplementary material

          The online version of this article (10.1186/s40794-019-0081-0) contains supplementary material, which is available to authorized users.

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          Most cited references76

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          Ethics and Best Practice Guidelines for Training Experiences in Global Health

          Academic global health programs are growing rapidly in scale and number. Students of many disciplines increasingly desire global health content in their curricula. Global health curricula often include field experiences that involve crossing international and socio-cultural borders. Although global health training experiences offer potential benefits to trainees and to sending institutions, these experiences are sometimes problematic and raise ethical challenges. The Working Group on Ethics Guidelines for Global Health Training (WEIGHT) developed a set of guidelines for institutions, trainees, and sponsors of field-based global health training on ethics and best practices in this setting. Because only limited data have been collected within the context of existing global health training, the guidelines were informed by the published literature and the experience of WEIGHT members. The Working Group on Ethics Guidelines for Global Health Training encourages efforts to develop and implement a means of assessing the potential benefits and harms of global health training programs.
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            A Guide to Writing a Qualitative Systematic Review Protocol to Enhance Evidence-Based Practice in Nursing and Health Care.

            The qualitative systematic review is a rapidly developing area of nursing research. In order to present trustworthy, high-quality recommendations, such reviews should be based on a review protocol to minimize bias and enhance transparency and reproducibility. Although there are a number of resources available to guide researchers in developing a quantitative review protocol, very few resources exist for qualitative reviews.
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              High incidence of hospital admissions with multidrug-resistant and extensively drug-resistant tuberculosis among South African health care workers.

              Nosocomial transmission has been described in extensively drug-resistant tuberculosis (XDR-TB) and HIV co-infected patients in South Africa. However, little is known about the rates of drug-resistant tuberculosis among health care workers in countries with high tuberculosis and HIV burden. To estimate rates of multidrug-resistant tuberculosis (MDR-TB) and XDR-TB hospitalizations among health care workers in KwaZulu-Natal, South Africa. Retrospective study of patients with drug-resistant tuberculosis who were admitted from 2003 to 2008 for the initiation of drug-resistant tuberculosis therapy. A public tuberculosis referral hospital in KwaZulu-Natal, South Africa. 231 health care workers and 4151 non-health care workers admitted for initiation of MDR-TB or XDR-TB treatment. Hospital admission rates and hospital admission incidence rate ratios. Estimated incidence of MDR-TB hospitalization was 64.8 per 100,000 health care workers versus 11.9 per 100,000 non-health care workers (incidence rate ratio, 5.46 [95% CI, 4.75 to 6.28]). Estimated incidence of XDR-TB hospitalizations was 7.2 per 100,000 health care workers versus 1.1 per 100,000 non-health care workers (incidence rate ratio, 6.69 [CI, 4.38 to 10.20]). A higher percentage of health care workers than non-health care workers with MDR-TB or XDR-TB were women (78% vs. 47%; P < 0.001), and health care workers were less likely to report previous tuberculosis treatment (41% vs. 92%; P < 0.001). HIV infection did not differ between health care workers and non-health care workers (55% vs. 57%); however, among HIV-infected patients, a higher percentage of health care workers were receiving antiretroviral medications (63% vs. 47%; P < 0.001). The study had an observational retrospective design, is subject to referral bias, and had no information on type of health care work or duration of occupational exposure to tuberculosis. Health care workers in this HIV-endemic area were substantially more likely to be hospitalized with either MDR-TB or XDR-TB than were non-health care workers. The increased risk may be explained by occupational exposure, underlining the urgent need for tuberculosis infection-control programs.
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                Author and article information

                Contributors
                +61 2 62442015 , ashley.watson@act.gov.au
                nick.cooling@utas.edu.au
                ian.woolley@monash.edu
                Journal
                Trop Dis Travel Med Vaccines
                Trop Dis Travel Med Vaccines
                Tropical Diseases, Travel Medicine and Vaccines
                BioMed Central (London )
                2055-0936
                3 April 2019
                3 April 2019
                2019
                : 5
                : 4
                Affiliations
                [1 ]ISNI 0000 0001 2180 7477, GRID grid.1001.0, Australian National University Medical School - Canberra Hospital Campus, ; Garran, ACT Australia
                [2 ]ISNI 0000 0004 1936 826X, GRID grid.1009.8, School of Medicine, , University of Tasmania, ; Tasmania, Australia
                [3 ]ISNI 0000 0004 1936 7857, GRID grid.1002.3, Monash Infectious Diseases, Monash Health and Monash University, ; Clayton, Victoria Australia
                Author information
                http://orcid.org/0000-0002-3067-8643
                Article
                81
                10.1186/s40794-019-0081-0
                6448218
                30988957
                da2f7f88-7624-487e-9695-82c89a6a53d3
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 October 2018
                : 26 March 2019
                Categories
                Review
                Custom metadata
                © The Author(s) 2019

                global,ethics,travel,occupational,risk
                global, ethics, travel, occupational, risk

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