Planning an International Ophthalmology Elective: First-hand Insights and Advice to Make the Most of Your Experience

Sheryll Kamat 

Introduction

Undertaking an ophthalmology elective was one of the most valuable experiences of my medical school journey. Whether you’re considering a career in ophthalmology or simply exploring the field, an elective offers far more than clinical exposure. It provides a unique opportunity for personal and professional growth, immersing you in an unfamiliar environment, embracing cultural nuances, and deepening your understanding of eye care delivery across different healthcare systems. During my elective at the University of Malaya in Kuala Lumpur, I gained exposure to a wide range of ophthalmic conditions, assisted in clinics, observed specialised surgeries, and contributed to a project on low-vision aids. This experience was truly eye-opening, and in this reflection, I’ll share my insights on what worked, what didn’t, and what I wish I’d known before embarking on this journey.

1.     Planning and Preparation: What Worked

Thorough planning made all the difference. Here’s what helped me:

Finding the Right Placement

I used the MDU Elective Network as a starting point to explore various destinations. Student forums like The Student Room and Reddit were also invaluable for gaining insight into other students’ experiences. Additionally, the BMA offers a fantastic page with reflections from medical students about their elective journeys. I sought advice from consultants and trainees in my local ophthalmology department, and a recommendation ultimately led me to the University of Malaya, which proved to be an excellent choice.

MDU Elective Network: https://studentnotes.themdu.com/issue-archive/spring-2018/top-ten-elective-destinations

BMA Enjoy your elective: https://questionnaires.bma.org.uk/news/elective/index.html

Application

After completing my research, I emailed the elective coordinator at the university with a completed application form and a personalised email highlighting my interests and objectives. They were incredibly supportive and provided clear details about the admission process, fees, and placement. Additionally, they kindly shared our supervisor’s contact information, allowing us to reach out before our arrival.

Tips: 

  • Many institutions offer formal elective programs with clear application processes and deadlines. Research early to avoid missing out! 
  • Keep an eye out for elective grants and bursaries, there are many charities, trusts and organisations that provide funding for medical school electives.
  • Certain organizations, such as Work the World, provide tailored placements, including accommodation, structured programs, and step-by-step support throughout the process.

Medical Schools Council Elective Bursaries: https://www.medschools.ac.uk/studying-medicine/current-medical-students/elective-bursaries

Work the World, Healthcare Elective Placements Abroad: https://www.worktheworld.co.uk/

The University of Malaya Elective Postings: https://medicine.um.edu.my/elective-postings

Practicalities

Sorting out visas, flights, and accommodation early helped me avoid stress later. My advice? Book flexible tickets and research housing options thoroughly, especially when travelling abroad. We contacted the hospital’s elective coordinator, who provided recommendations for student-friendly accommodation in safe areas. We also downloaded an eSIM called ‘Holafly,’ which was an affordable and reliable way to ensure we always had internet access and could stay connected with friends and family back home.

Tips: 

  • When choosing where to stay, consider factors such as transportation, safety, and proximity to essential services.
  • Consider purchasing an eSIM when travelling abroad. Having a reliable internet connection is essential for navigating unfamiliar places, staying in touch with loved ones, and accessing essential information on the go.

Preparing Clinically

Before the elective, we revisited our medical school ophthalmology material to solidify our understanding of basic anatomy and common conditions. We also reached out to our ophthalmology department to spend an evening practising with the slit lamp and fundoscopy, which helped enhance our examination skills. This preparation proved to be extremely useful during the elective!

2.     Setting Goals: What Do You Want to Achieve?

Before starting, think deeply about what you hope to get out of your elective. For me, it was a mix of academic, professional, and personal goals:

Academic Goals

My primary academic goal was to expand my knowledge of ophthalmology, particularly in subspecialties and surgical procedures I had not yet encountered. I was also eager to understand how conditions like cataracts and glaucoma are managed within diverse healthcare settings and to explore how barriers to eye care are addressed in resource-constrained environments.

Professional Growth

The elective provided an opportunity to enhance my clinical skills, particularly in communication. Anticipating that many patients might not speak English, I knew that I would need to rely on translators. I aimed to develop key transferrable skills including the use of non-verbal cues, adaptability, patience and understanding.

Personal Growth

I was eager to immerse myself in Malaysian culture, exploring local cuisine, learning about traditional customs, and visiting iconic landmarks. Before my arrival, I conducted a quick Google search for local recommendations and created a personalized itinerary to make the most of my weekends and evenings off.

Tips:

  • Write down your objectives before starting your elective to stay focused and make the most of your experience. 
  • Research the country and institution to identify unique opportunities you may not have seen before or may not encounter again.

3.     Challenges: What I Faced and How I Overcame Them

No elective goes perfectly smoothly, but each challenge brings valuable lessons. Here are a few I encountered:

Language Barriers

While most doctors and staff spoke English, many patients did not. Although I anticipated this, applying it in real life proved to be challenging. We made sure our supervisors were aware that we wanted to be as involved as possible and even asked if they could help facilitate translation when taking patient histories. We downloaded a language learning app called Duolingo to learn key phrases in Malay and aid in more complex translation. This proved incredibly helpful in both clinics and for things such as directions or ordering food. 

Tip:

  • Learn a few basic phrases in the local language. It shows respect and can help break the ice with patients. 
  • Be sure to download a language translation app, such as Duolingo or Google Translate, when travelling to countries where English is not the primary language.

High Patient Turnover

The sheer volume of patients and fast pace was overwhelming and unlike anything I had experienced before. The department had over 30 rooms running simultaneously, each covering different specialities. There were easily over 100 patients in the waiting area at any given time. On our first day, we often stood outside, trying to figure out the system and how and when to enter a room discreetly. Fortunately, an ophthalmologist noticed our uncertainty and guided us, introducing us to the staff and showing us how things worked. Initially, adjusting to this was challenging, but over time, I appreciated how efficiently the team managed their workload.

Tip: 

  • Don’t hesitate to ask for guidance or clarification and be adaptable in high-pressure environments. Everyone knows you’re a student and is usually happy to help. 

Logistics

Navigating a new city and its transport system was initially daunting. The unfamiliar routes, language barriers, and different transportation methods made getting around challenging. Fortunately, the elective coordinator provided helpful tips on using local taxis, public transport, and ‘Grab’ (a regional Uber equivalent), which made travel safer and more efficient.

Tip: 

  • Group travel is safer and often more enjoyable. Exploring the city with fellow students not only eases the experience but also creates great memories. 
  • Remember currency conversion and interest rates; some banks, such as Monzo, don’t charge interest for international card use. It’s always helpful to carry some cash in the local currency in case of emergencies.

4.     Getting Involved: Extra-Curricular 

We reached out to our educational supervisor early to express our interest in getting involved with projects. This proactive approach enabled us to undertake a project on low-vision aids, which we later presented to the department. The experience was particularly educational, as it required us to delve into issues such as accessibility, costs, and product availability in Malaysia, factors that differed significantly from those in the UK. 

Tip: 

  • Be proactive. If you show interest and initiative, supervisors are more likely to involve you in meaningful tasks.

5.     Cultural Immersion: Lessons Beyond Medicine

One of the highlights of my elective was exploring Malaysia. From sampling street food to learning about local festivals, I embraced every opportunity to immerse myself in the culture. We spent our afternoons and weekends off sightseeing at landmarks like the Petronas Towers, Batu Caves, and KLCC Park.

Being aware that our visit coincided with Ramadan, a festival observed by Muslims worldwide, allowed us to approach our stay with greater cultural awareness and understanding. This also provided a meaningful opportunity to observe how healthcare professionals adapted their guidance for patients fasting during Ramadan, particularly those managing chronic conditions like diabetes. 

Tip: 

  • Make time to explore. Balancing work and leisure not only enriches your experience but also helps you unwind after busy clinical days.
  • Research your overseas destination in advance to ensure you are aware of local customs and traditions, ensuring cultural sensitivity and respect

6.     Reflecting on the Experience

Throughout my elective, I made it a point to document and journal my experiences. As the end approached, I realized how much this elective had shaped me. It wasn’t just the clinical knowledge, but the adaptability, cultural competence, and confidence I gained along the way. An ophthalmology elective is a unique journey that goes far beyond clinical training. It’s about stepping into new environments, embracing challenges, and growing both as a clinician and an individual.

Tip: 

  • Reflect on what you’ve learned, both professionally and personally, this is crucial for showcasing your experiences and development.
  • Be sure to collect signed evidence of your elective to include in future portfolio applications. 

Final Thoughts

If I could offer one piece of advice, it’s this: Be curious and open-minded. Whether you’re navigating a bustling clinic, sampling local delicacies, or learning from a complex case, every moment has something to teach you. Would I do it all over again? Absolutely. And I hope this guide helps you make the most of your own elective journey.

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