Published 29 December 2008, doi:10.1136/bmj.a2874
Cite this as: BMJ 2008;337:a2874

Analysis

Ethical Debate

Students whose behaviour causes concern: Case history

What should you do when you see a fellow student behaving inappropriately? After a group of students wrote to the BMJ about their experience during an elective, we sought the opinions of an ethicist (doi:10.1136/bmj.a2882), a dean (doi:10.1136/bmj.a2884), a GMC representative (doi:10.1136/bmj.a2876), and a lecturer from an African university (doi:10.1136/bmj.a2875)

Medical students are in a position of privilege and trust in their everyday interactions with patients. The General Medical Council (GMC) guidance states that students must protect patients from harm posed by another colleague’s poor behaviour, performance, or health and raise any concerns with an appropriate person.¹ However, there is no obvious channel for raising concerns, particularly when problems are encountered away from your university. We describe our experiences, which highlight the issues encountered when students abuse their position.

Unethical behaviour

We spent an elective placement in a busy hospital in a developing country. Our supervisor was a western doctor who went on annual leave for the last three weeks of our placement. One day before the supervisor’s departure a new student arrived from the United Kingdom. He was shown around and had the opportunity to observe in theatre before our supervisor left. We later discussed with him our experiences since arrival and mentioned that we had been offered opportunities to perform procedures for which we lacked competence and training, such as inserting chest drains and hernia operations, which we had firmly declined. He replied that he couldn’t "wait to get into theatre and have a go," a comment we assumed to be in jest.

Over the following week we became increasingly concerned by his attitude after several incidents, including altering a prescription written by a local doctor to an alternative antimicrobial drug despite being unaware of local sensitivities, photographing patients having invasive and intimate procedures without consent, and performing an unnecessary lumbar puncture because he "fancied having a go."

The local healthcare professionals sometimes perceived white skin to be synonymous with expertise, placing unprecedented levels of trust in us and allowing us to make decisions and perform procedures that would be unacceptable in the United Kingdom. Although we relished the thought of learning advanced new procedures, we thought this would be unethical. The new student considered it an opportunity to gain valuable experience where "it doesn’t matter if we mess up—no-one would know." He recounted how, on placements in the UK, he introduced himself as a doctor rather than student because "patients won’t let you do anything otherwise."

We unsuccessfully attempted to discuss our concerns with him before approaching a more senior doctor, who also had concerns and agreed to contact our supervisor. However, the student left for the weekend and did not return, his assessment form having been completed on his first day because of the supervisor’s imminent departure. We were informed that our supervisor thought that because the student had left the hospital the issue was resolved.

Where next?

We were uncomfortable with the lack of resolution and concerned that, were the student to be involved in further incidents, our failure to report our concerns could leave us accountable. However, we were unsure of the appropriate course of action. We were concerned that contacting his medical school without the support of our supervisor or evidence other than our observation might be considered unprofessional. In fact, and unbeknown to us at the time, our supervisor did later contact the student’s medical school. However, before we knew this, we had sought advice from senior doctors, and it seemed to us that there was no consensus on the appropriate course of action for undergraduates causing concerns.

Cite this as: BMJ 2009;338:a2874

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Names and addresses withheld.

Competing interests: None declared.

References

1. General Medical Council. Medical students: professional behaviour and fitness to practise. 2007. www.gmc-uk.org/education/undergraduate/undergraduate_policy/professional_behaviour.asp.

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