title: Attitudes of Palestinian medical students on the geopolitical barriers to accessing hospitals for clinical training: a qualitative study.
abstract: BACKGROUND
  The movement of Palestinians in the occupied Palestinian territories is restricted by bureaucratic and physical obstacles. To date, no studies have examined the barriers that Palestinian medical students face in accessing hospitals for clinical training. The objectives of this study were to characterize these barriers and understand how they affect Palestinian students' medical education and quality of life.
  
  
  METHODS
  Convenience sampling was used to recruit 4th-6th year medical students from Al-Quds University to participate in focus group discussions. A total of 36 students participated in the discussions. Transcripts of the discussions were coded to identify major themes.
  
  
  RESULTS
  Palestinian medical students expressed facing numerous challenges during their clinical training. Students emphasized the difficulties of obtaining permits to train at Jerusalem hospitals, including arbitrary permit rejections and long wait times. Significant delays, searches, and mistreatment at checkpoints during their commute to hospitals were particularly burdensome. The majority of students who participated in the focus groups felt that their education and quality of life had been strongly negatively affected by their experience trying to access hospital training sites.
  
  
  CONCLUSIONS
  Our findings suggest that medical students living and studying in the occupied Palestinian territories receive sub-optimal training due to ambiguous permit rules, barriers at checkpoints, and the psychological burden of the process. These results highlight the impact that military occupation has on the education and quality of life of Palestinian medical students in a setting in which there is regular violence and many health indicators are already poor.
authors.affiliation: Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA.
authors.forename: Sarrah
authors.initials: S
authors.lastname: Shahawy
authors.affiliation: Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Diamond
keywords: Al-Quds University; Medical education; Medical students; Occupation; Palestine; West Bank