Even with predeparture counseling, these students were unable to comprehend the gravity of their potential exposure risk. Only 24% of private and 36% of public medical school respondents to the GHEC survey indicated check details that they offered a general pretravel preparatory course through which information regarding adequate needlestick prophylaxis could be reviewed.3 As greater numbers of medical students participate in international rotations, the medical community will have to address this issue. Locally, medical schools and hospitals will have to take on the responsibility of educating students on the risks associated with working in resource-poor countries,

providing pretravel education and supplies for them to adequately protect themselves, and ensuring that there is follow-up care for diagnostic testing and monitoring of potential adverse events associated with PEP. Many institutions already have established PEP protocols. However, national and international organizations have yet to develop a specific protocol or a universal standard of care for traveling students. Given the rising numbers of participants in international health electives, there is a growing need to develop a set of consensus guidelines

for PEP for medical students and residents to ensure their health and safety when they work abroad. As interest in participating in international electives in HIV-endemic countries increases, medical schools and residency programs with sanctioned international

health programs need to understand selleck chemical the risks faced by their trainees and develop comprehensive 3-mercaptopyruvate sulfurtransferase programs to protect them. Working in a resource-rich environment can often lull students into a sense of safety given the relatively low burden of blood-borne infectious diseases in the patient population, adequate access to supplies allowing adherence to universal precautions, and ready access to occupational health or emergency medical services. In settings where both health care workers and resources are limited, trainees may be placed in situations where they are performing risk-prone procedures on individuals who are potentially HIV-infected and/or chronic hepatitis B or C carriers. For those institutions with international elective opportunities, the goal should be to develop a standard protocol for predeparture education and postexposure intervention (Table 1). In addition to predeparture education reviewing itinerary-specific risks, preventive measures, and health care limitations in a resource-poor environment, students should receive training that allows them to appropriately identify a medium- to high-risk clinical exposure and then follow the postexposure protocol. This could be done as a formal lecture or through the use of an on-line educational module that they would be required to complete prior to international travel.