A new model of clinical placement in the Solomon Islands

Introduction: Electives and selectives in developing countries are an important part of students learning experiences. During 2013 Bond University on the Gold Coast in Australia piloted final year undergraduate medical student placements (n=33) at Kira Kira Hospital, on Makira Island in the Solomon Islands. The placement was evaluated that year. Methodology: A scoping study was undertaken in 2012. The evaluation included: a desktop review, semi-structured interviews with participating Bond and Kira Kira staff, and community members (n=16), undertaking an electronic survey (n=18) and a focus group with participating students (n=9), and the development of a written report with recommendations. Results: The evaluation found that this was an extremely valuable, personally safe, clinically fascinating, and professionally life changing student experience, which was greatly appreciated by, and contributes to, the local Kira Kira community. The greatest strength of the program was the peer mentoring and supervisor model – whereby 4 students worked in pairs supported by nurses, the doctor and local community. The main challenges were the supervision arrangements and available resources. Conclusion: Placements in developing countries can be career highlights for all students. This placement now has a solid foundation, is philosophically sound and provides multidisciplinary Australian students with a great experience, but leaves a long term legacy to the community as a result. Introduction Medical students undertaking electives in developing countries has increased over the past decade (Cooke, 2011; Law, Worley, & Langham, 2013). Many of these placements are undertaken by one student at a time who often organises it themselves (Al-Samarrai, 2011). In Australia 53% of graduate entry medical students and 35% of high school entry students undertake an international placement during their education (Law et al., 2013). These experiences are viewed as an important part of students learning experiences, where they often get to see fascinating medicine and tropical and communicable diseases that they never would in their own first world countries, as well as having a professional and personal experience that may change their life or future career path (Cooke, 2011; Radstone, 2005). There is however little evidence regarding the impact these placements have on addressing the local community’s health care needs and the contribution they make in communities where resources are already stretched (Cooke, 2011; Lumb & Murdoch-Eaton, 2014; Radstone, 2005). About the Solomons The population of Solomon Islands is over 565,000 but its total Gross Domestic Product (GDP) per person is less than 2% of Australia’s per capita GDP (DFAT, 2014). The Solomon Islands are ranked “low” on the Human Development Index (HDI) (United Nations, 2014a), which is on par with many of the nations in Sub-Saharan Africa and is a long way to achieving the Millennium Development Goals as they pertain to health (United Nations, 2014b). In 2006, the Solomon Islands were considered the poorest of the pacific island nations and one where Australia has made substantial support via AUSTaide (DFAT, 2014). The Solomons also suffers serious medical recruitment and retention problems with only an estimated 100 doctors for a population of 565,000, of whom 75% work in The National Referral Hospital in the capital Honiara. Most doctors outside Honiara work in solo or two doctor hospitals. In 2012, Bond University medical school decided to explore opportunities for innovative elective placements, for its final year undergraduate medical students, in the Solomon Islands in the Pacific.