The contribution and challenges of electives in the development of social accountability in medical students.

Overseas electives are a key feature of western medical schools, with a high proportion of senior students taking the opportunity to travel to poorly resourced countries. Development of enhanced clinical skills is the focus of most electives; however, they provide a valuable opportunity to enhance medical students' sense of social accountability. Medical schools have a responsibility to ensure adequate preparation by the students, including close liaison and negotiation with host institutions to ensure maximal benefit for both student and the host communities. Anticipating intended and unintentional learning outcomes, which relate not only to global health knowledge and clinical skills but incorporate explicit expectations of a range of generic, professional and social responsibility outcomes, will help to ensure maximum benefit. Incorporating reflective accounts and host feedback into elective assessments will contribute to students' development, and ensure viability and sustainability of this valuable learning opportunity.