Study abroad and exchange in Medicine

The fifth-year student opens the university's mobility call: places at teaching hospitals in other countries, an application deadline in two months, a language proficiency requirement and a letter from the coordinator. She thinks about everything she could learn, but also about practical questions: is it worth interrupting the internship, how should she prepare, what can and can't a student do in a foreign hospital?

NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.

Exchange programs and internships abroad are memorable experiences in medical training for those who manage to do them. They also involve risks and ethical dilemmas that rarely appear in enthusiastic accounts. This guide shows what studies say about gains and risks, the most common dilemmas, how to prepare before traveling and how to turn the experience into learning on your return.

Key points

• Reviews describe gains in clinical knowledge, physical examination, judicious use of resources, cultural competence and professional development.
• The same reviews point to risks to the student's health and safety during the trip.
• Students report ethical dilemmas linked to lack of resources and pressure to act beyond what they know.
• Language barriers were the main challenge cited by students in clinical placements in sub-Saharan Africa.
• Preparation before the trip and a structured conversation on return help, but are often missing.

Types of experience abroad

Academic exchange

Mobility programs with agreements between universities allow students to take courses or internships at another institution, with credits recognized on return. They usually involve a call for applications, a selection process and language and academic performance requirements.

Clinical internship abroad

These are short periods, of a few weeks, at hospitals or services in another country, often during the internship. They can be organized by the university, by student associations or directly by the student with the host institution. Choosing elective internships in general, including in Brazil, has its own guide in this series.

Research abroad

Periods in foreign laboratories or research groups are another entry point, often linked to undergraduate research and specific scholarships.

Where students go

An analysis of 856 accounts of internships abroad written by German-speaking medical students found Europe to be the most sought-after destination, with interest in the United States much lower than expected (Storz et al., 2021). Internships in low- and middle-income countries were less popular than in high-income countries, and general surgery was the most chosen field (Storz et al., 2021).

The authors observed wide variation in choices, probably influenced by financial, organizational and geopolitical factors, and suggest that a single preparation for all destinations is insufficient (Storz et al., 2021).

What the studies show

Gains described

A systematic review of 10 studies on global health internships of American internal medicine and pediatrics residents identified four positive themes (Lu et al., 2018). They were: improvement in medical knowledge, physical examination and procedural skills; more judicious use of resources; cultural and interpersonal competence; and professional and career development (Lu et al., 2018).

The studies involved residents, and the gains are largely perceived by the participants themselves. Still, the pattern repeats in student accounts: dealing with fewer resources forces you to value the clinical history and physical examination.

Risks described

The same review identified two negative themes: risks to participants' health and risks to their safety (Lu et al., 2018). The authors ask educators to recognize these challenges and prepare travelers (Lu et al., 2018). Infectious diseases, exposure to biological material, traffic accidents and situations of violence are among the concerns most cited in the global health literature.

The students' experience

In a qualitative study with 29 students from Western countries on clinical placements at seven sites in sub-Saharan Africa, participants rated the experience very positively and seemed aware of their clinical limits (Kumwenda et al., 2014). Language barriers were the main challenge, even where English was the second language, and training before the trip was considered useful but of little clinical relevance (Kumwenda et al., 2014).

Students who stayed longer, were closer to graduation or worked in rural units contributed more to patient care (Kumwenda et al., 2014). On some occasions there were misunderstandings about student status (Kumwenda et al., 2014).

Lessons beyond technique

In a study with students from Singapore on a community project in Nepal, the lessons included humanism, social determinants of health, communication across language barriers, adaptability and health equity (Nadarajan et al., 2024). Written reflections and following patients' trajectories helped achieve these outcomes (Nadarajan et al., 2024).

Ethical dilemmas and safety

What students face

In a study with 23 Canadian students who did 38 global health placements during their undergraduate studies, in 23 countries, 60% had training before the trip and only 36% had a structured conversation after the experience (Dell et al., 2014). Three major themes emerged: differences in resources and care provision, clinical ethical dilemmas and threats to student safety (Dell et al., 2014).

The authors concluded that students are often poorly prepared for the ethical and safety dilemmas they encounter and that they need intensive training before the trip, including on how to respect their own clinical limits (Dell et al., 2014).

Acting within limits

The most common dilemma is pressure, explicit or implicit, to perform procedures or make decisions beyond what a student would do in their own country. The rule is simple to state and hard to follow: abroad, the student does only what they would be authorized to do at home, with the same supervision. The shortage of professionals on site is a real problem, and the response to it is institutional, not improvisation by someone still in training.

Benefit for whom?

A review on training before the trip, discussed from the standpoint of social responsibility, warns that the benefits of these placements for students and communities may not outweigh the harms (Wallace and Webb, 2014). The authors advocate bilateral partnerships, in which host communities and institutions are treated as main parties in the training and in the evaluation of programs (Wallace and Webb, 2014).

For the student, this becomes a practical question: does my placement have a local partner that benefits from my presence, or will I take up time and resources from an already overstretched team?

Personal safety

Check the official travel guidance for the destination, update your vaccinations in advance, take out health insurance that covers care and repatriation and know what to do in the event of an accident with biological material. Agree an emergency contact with your school and keep someone informed about your movements.

How to prepare

Choose carefully

• Supervision: who will be your preceptor and what will your role be?
• Partnership: is there an agreement between the institutions and a local person in charge?
• Recognition: will the period count toward your course?
• Language: can you talk with patients in the local language, or will there be an interpreter?
• Duration: longer periods allow you to contribute more and learn more.

Prepare your clinical language

Even someone who speaks a foreign language well may struggle with clinical terms, abbreviations and popular expressions for symptoms. Study the vocabulary of history taking and physical examination before you travel and practice presenting cases in the destination language.

Study the context

Read about the country's health system, the most frequent diseases in the region and the local clinical guidelines. Diseases that are rare in Brazil may be common at the destination, and the reverse is also true. Reviewing your reasoning from signs and symptoms helps; the guide on signs, symptoms and history is a good starting point.

Plan the practical side

Documents, visas, insurance, housing and local transport take time. Start early and keep digital copies of everything. Institutional programs and student associations usually have updated guides and contacts of people who have already been.

Training before the trip

If your school offers preparation before the trip, take part. If it does not, meet with students who have returned from the same destination and with an experienced professor to discuss hypothetical ethical cases: what to do if you are asked to perform a procedure you have never done, if supplies are missing or if a patient asks for something outside the service's rules.

During and after

During

Observe before acting, ask how things work there and respect local routines. Keep a short diary with cases, questions and difficult situations. This record helps you reflect and remember details when you return.

Take care of yourself too. Tiredness, homesickness and the shock of realities very different from your own are common in the first weeks. Staying in touch with someone you trust, sleeping enough and talking with colleagues in the group about what they are going through helps you get through this phase without losing what is best about the experience.

On your return

Ask for a structured conversation with a professor or with the group that traveled, to discuss what happened, including the uncomfortable situations. Only a minority of the students in the Canadian study had this kind of conversation (Dell et al., 2014), and it is there that the experience becomes learning.

Share and record

Present the experience to colleagues, help those going next and record the period on your CV; the Lattes CV has its own guide in this series. If possible, keep in touch with the host institution so the partnership continues.

Reasoning anywhere with NEXO

A well-reasoned clinical case works in any country. The NEXO case of the day is fictional, with a real clinical presentation, and the diagnosis arrives in up to six clues, with the ICD-10 proximity showing how far each guess was. For those far from the school routine, it is a short way to keep diagnostic reasoning sharp between shifts.

The guide what NEXO is explains the whole game, and the release of the modes is on the NEXO Economy page.

If you coordinate a medical school, a student league or a residency and want cases to prepare students before the trip, see NEXO Closer. Researchers in medical education can propose studies through NEXO Researcher. Doctors who review cases take part through NEXO Curator, and those who create health content on social media can take part through NEXO Creators.

Frequently asked questions

Is a Medicine exchange worth it?

Reviews describe gains in knowledge, physical examination, cultural competence and career, along with health and safety risks (Lu et al., 2018).

What is the biggest challenge?

Among students on placements in Sub-Saharan Africa, language barriers were the main challenge (Kumwenda et al., 2014).

What can a student do in a foreign hospital?

Only what they would be authorized to do in their own country, with equivalent supervision.

How to prepare?

Choose a program with supervision and a local partnership, study the clinical language and the health context and take part in training before the trip.

Where do students go?

Among German-speaking students, Europe was the most sought-after destination (Storz et al., 2021).

What to do on your return?

A structured conversation about the experience, including the difficult situations, and recording it on your CV.

Exchange checklist

1. Check the supervision and the local partnership.
2. Ensure recognition of the period in the course.
3. Study the clinical language of the destination.
4. Read about the health system and local diseases.
5. Take care of vaccines and insurance in advance.
6. Respect your clinical limits.
7. Talk about the experience on your return.

Want to keep your reasoning sharp wherever you are? Play the case of the day on NEXO.

References

1. Storz MA, Lederer AK, Heymann EP. German-speaking medical students on international electives: an analysis of popular elective destinations and disciplines. Global Health. 2021. https://pubmed.ncbi.nlm.nih.gov/34399794/
2. Lu PM, Park EE, Rabin TL, Schwartz JI, Shearer LS, Siegler EL, et al. Impact of Global Health Electives on US Medical Residents: A Systematic Review. Ann Glob Health. 2018. https://pubmed.ncbi.nlm.nih.gov/30779519/
3. Kumwenda B, Royan D, Ringsell P, Dowell J. Western medical students' experiences on clinical electives in sub-Saharan Africa. Med Educ. 2014. https://pubmed.ncbi.nlm.nih.gov/24807435/
4. Nadarajan GD, Rasappan K, Ng JSY, Junchen ML, Yoon S. Medical students' experience and learning outcomes of overseas community involvement project: a qualitative study. BMC Med Educ. 2024. https://pubmed.ncbi.nlm.nih.gov/39118034/
5. Dell EM, Varpio L, Petrosoniak A, Gajaria A, McMcarthy AE. The ethics and safety of medical student global health electives. Int J Med Educ. 2014. https://pubmed.ncbi.nlm.nih.gov/25341214/
6. Wallace LJ, Webb A. Pre-departure training and the social accountability of International Medical Electives. Educ Health (Abingdon). 2014. https://pubmed.ncbi.nlm.nih.gov/25420975/