The Final Year Elective gives you the opportunity of undertaking a period of study, or clinical experience, in an area of medicine that is of particular interest to you. Objectives of your Elective project are for you to demonstrate your ability to: Develop and work to a set of realistic aims and objectives Manage your own time and prioritise tasks effectively Take account of medical ethics when practicing Present your preparatory work in writing, clearly and concisely Reflect on your practice and be self-critical OFFICIAL BRISTOL UNIVERSITY MEDICINE YEAR 5 ELECTIVE HANDBOOK Please visit the Medical School Intranet under the Year 5 section to find the most up-to-date edition of the Elective Handbook.

Home/abroad Developing/developed country Safety of the country (www.fco.gov.uk) Language barriers Climate Infectious diseases Things to do outside work Whether you want to go alone or with a friend NB: Elective periods can combine two different parts i.e. a developed country followed by a developing country. Download the BMA electives Toolkit

The Elective Network from the MDU. This website should be your first port of call, containing lots of official information, including information about safety of placements and bursaries and stacks of electives reports from all over the world. Signing up is free (but requires your MDU membership number). Hospital staff e.g. your elective supervisor The Internet (look below for a starting list!) RECOMMENDED ELECTIVE SITES: BMA Charity organisations PDF BMA Checklist PDF The Electives Network www.worktheworld.co.uk or for a short version click here. www.medicstravel.com www.medicsaway.co.uk Student BMJ BOOKS: WHO: Directory of Medical Schools Medics Guide to Work and Electives around the World by Mark Wilson (several copies in the Medical Library)

Details of bursaries and prizes funding elective study administered by the Faculty of Medicine are available in the Elective Office and at the back of the fourth year handbook Writing to people Drugs companies Equipment suppliers Local companies Your school Rotary clubs Grants-books for general grants: The Directory of Grant Making Trusts The Grant Register Educational Grants Directory Sponsorship for Students The Medics Guide NOTE: Research will increase your chance of getting funding (for more details, visit the Medical Research Council)

Have the appropriate vaccinations and anti-malarial Get visas if required Get indemnity from MPS or MDU Get Travel insurance – BMA offer a tailored medical elective travel insurance. HEALTH AND SAFETY RISK ASSESSMENT You must think very seriously about any possible risks to your health and safety (physical or mental) during your Elective and complete a risk assessment for your travels. What is a risk assessment? A risk assessment is a careful examination of what, during your Elective, could cause you or others harm, so that you can weigh up what precautions you should take before and during your Elective to prevent or minimise any risk of harm. On your Electives Registration Form there is a risk assessment section which you must complete. To minimise risks and their effects you must: Ensure that the Foreign and Commonwealth Office does not recommend against travel to your chosen country/region. (https://www.gov.uk/foreign-travel-advice). Maintain effective lines of communication while on Elective with your next of kin or other responsible adult – use email or mobile telephone links if possible. You are also required to provide the name and address of the local supervisor at your Elective destination. Where possible please provide their telephone number and e-mail address so that the University may contact you through this route if necessary. Obtain comprehensive travel insurance from BMA Services or similar and ensure you have adequate funds for your trip. Travel insurance must cover medical emergency & travel expenses, repatriation, personal liability, premature return, baggage and personal effects, money & credit cards. You may wish to purchase insurance cover for change of venue because of a national disaster or an outbreak of disease or if you have to remain in the UK to resit examinations or for some other reason. Make sure you know how to contact your insurance company and take a copy of your insurance details with you. Discuss your health and safety with your Electives supervisor and/or the Electives Co-ordinator. Read ‘Risk Assessment for Contagious Diseases while on Student Electives’ and address any issuesraised. (see below). Prepare a first aid kit as appropriate to your destination country. Note that if you go to an HIV endemic area on your Elective remember that it is particularly important that you address risk assessment and management – you will have to pay for your own prophylactic medicines or equipment. You may also have to purchase other medical items such as latex gloves. Ensure that you are aware of health & safety regulations and procedures at your host institution, including whether you need an up to date Criminal Records Check from the Disclosure and Barring Service – you will need to pay for this yourself and apply at least 3 months in advance. Make yourself aware of what to do and who to contact if something should go wrong. Check which vaccinations you need at least three months prior to departure. You can obtain these from Student Health, your GP or a travel clinic. You should expect to pay for these (see below). Ensure you are familiar with local laws and customs. ELECTIVE RISKS You need to identify risks which are specific to your Elective. The following checklist of issues is adapted from ‘Health & Safety Guidance when Working Overseas’. You should work your way through this checklist to ensure that you have considered these potential hazards: Transportation – poor drivers, hazardous terrain, maintenance of vehicles, etc. (Note that traffic accidents are the main cause of deaths among travellers.) Invalid passports, which do not comply with entry criteria. Invalid visas and other documentation for travel (may need ‘work’ or other visa for an Elective) Cultural misunderstandings (customs, dress, religion) Legal differences – local standards, local statutes. Insecure or inappropriate accommodation Theft and other crime Infectious diseases Contact with animals (wild or domestic) – allergies, asthma, bites, rabies, malaria, etc. Contaminated drinking or other water (diarrhoea, Legionella, cholera, polio, etc.) Contaminated food (allergies, food poisoning, Hepatitis A) Electricity – compatibility of equipment and supply, etc. Emergencies (including fire) – arrangements and procedures, first aid provision, etc. Hazardous substances/chemicals/radiation Needles and other possible sources of cross contamination (HIV, Hepatitis B) Stress (due to accommodation problems, communication difficulties, loneliness, etc.) Climatic extremes Natural phenomena – avalanche, tsunami, earthquake, volcanoes, etc. Civil unrest/terrorist activityThis list is not exhaustive. Depending on where you are based, there may be other hazards not included here. Any significant hazards should be listed in the risk assessment section of your Registration Form.You will be able to find information on the above potential hazards at: Foreign and Commonwealth Office website (https://www.gov.uk/foreign-travel-advice) WHO Global HIV/AIDS prevalence: http://www.who.int/topics/hiv_aids/en/ Health Protection Agency www.hpa.org.uk The National Travel Health Network and Centre (NaTHNaC) http://www.nathnac.org/index.htm Medical advice is also available from the Student Health Service or your GP ‘Health & Safety Guidelines when Working Overseas’ Universities and Colleges Employers Association: http://www.ucea.ac.uk/en/empres/hands/publications/index.cfm Consulates of the countries you are travelling to can give you visa information; their websites may also give you information on local laws and customs (see https://www.gov.uk/foreign-travel-advice for a list of consulates and their websites).

Whilst thinking about and planning your final year elective period, it is worth considering all of the following as it may affect the ease of planning the trip and overall cost. Services available under the NHS are clearly defined and there will be charges payable for anything else. 1. Immunisations a) Occupational Some institutions abroad may require you to have additional immunisations or possibly a blood test to prove that you have had certain immunisations e.g. MMR. There will be a charge for this blood test. In some institutions in North America they may require an immunisation which is not available in the UK and then you may need to pay for a medical certificate declaring this. You should be aware that these requirements may not be the same as those in the UK and decisions regarding immunisations will be made on clinical grounds only. b) Travel Hepatitis A, Typhoid, Tetanus, Diphtheria, Polio, and Cholera (for a certain subset of travellers) vaccinations are available free on the NHS. Any other travel vaccines that may be required you will have to pay for. Please check the SHS website for further information. 2. MRSA Swabs Several countries, e.g. Australia or New Zealand, require a certificate stating that you have had recent MRSA swabs that are negative. There is a charge for these and requirements may vary even within the same country. You should check documentation carefully and bring it with you to any appointment at Student Health with one of the Health Care Assistants. 3. Anti-malarials Malaria is a potentially lethal disease which is prevalent throughout Africa, Asia and S. America. You may require anti-malarial medication for the whole time you are abroad. Some are only available on a private prescription, for which there is a charge for the prescription and then you will also have to pay for the anti-malarial tablets. (See Appendix C for further information) 4. Certification Many institutions will require a statement of health and in some instances will even demand you have a chest x-ray. There will be a fee for both of these. 5. HIV Prophylaxis If you are travelling and working in a country where there is a high incidence of HIV e.g. Africa, then you may require HIV prophylaxis for which there is a charge. (See Appendix C for further information). This is obtained from Occupational Health. 6. Other Possible Costs These may arise if you decide to travel independently before or after your elective period e.g. a private prescription for antibiotics if you become unwell, or medication for altitude sickness if you are climbing. These are all available and cheaper to buy at one of the private travel clinics e.g. NOMAD Please consider all the above factors before you make your choice and finalise your plans. The staff at the Students’ Health Service have many years experience of helping elective students and would be happy to answer any queries you may have Please book into a travel clinic appointment at SHS as soon as you start planning your medical elective. SHS has a huge demand for travel clinic appointments for medical electives in February/March each year and availability of appointments cannot always fulfil demand during this time. PLEASE NOTE: This information is not exhaustive and further information can also be found on the websites referred to in the Student Health Handbook.

What resources are available for me to check what immunisations I need? http://www.fitfortravel.nhs.uk/home.aspx http://www.nathnac.org/travel Are there charges for malaria prescriptions? Some antimalarials are not available on the NHS and only available on private prescription, these include Malarone, Doxycycline and Mefloquine (Larium). There is a £14 private prescription charge at SHS and the pharmacy will then charge you for the individual tablets. Each pharmacy charges a different price so it is worth shopping around with your prescription. If Chloroquine and/or Proguanil antimalarials are recommended for your destination, these do not require a prescription and can be bought over the counter at a pharmacy. You can check the following website for further information on risk of malaria at your destination (malaria maps) and antimalarials recommended. http://www.fitfortravel.nhs.uk/home.aspx Where can I get a prescription of antibiotics to take with me to treat travellers’ diarrhoea? It is cheaper to buy these at NOMAD travel clinic on Park Street than to obtain them from SHS as they need to be issued on a private prescription which incurs a £14 prescription charge plus the price of the tablets from the pharmacy. Where can I obtain Acetazolamide (Diamox) for altitude sickness? This is an unlicensed medication in England, so not prescribed at SHS, however NOMAD sell it within their clinic. Where can I check how long my immunisations last for? When boosters are due? Information can be found on http://www.nathnac.org/pro/factsheets/index.htm

Country Contact database https://www.bris.ac.uk/medical-school/staffstudents/student/generalinfo/electivescountrycontactdatabase.xls (Link to the uni document, also found on the intranet) If there are any incorrect contact details or if you would like to add to the database then please get in touch at clinical@galenicals.org.uk Prizes/Bursaries: External elective bursaries https://www.bris.ac.uk/medical-school/staffstudents/student/externalelectivebursaries1415v1.pdf The Worshipful Society of Apothecaries of London – Conflict and Catastrophe Medicine Elective prize application form The Royal Society of Medicine https://www.rsm.ac.uk/prizes-awards/students.aspx Other sources of information: Bristol Medical School tips for raising funds: https://www.bris.ac.uk/medical-school/staffstudents/student/ Electives Network via the MDU website www.themdu.com The BMA http://bma.org.uk/search?query=elective The Royal Society of Medicine https://www.rsm.ac.uk/prizes-awards/students.aspx