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ANALYSIS: Moses Galukande Students whose behaviour causes concern: Am I my brother’s keeper? BMJ 2008; 337: a2875 [Full text]

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Practising on the Poor?

Samantha JJ Radstone   (26 January 2009)

Practising on the Poor? 26 January 2009
Samantha JJ Radstone, GP Registrar The Surgery, 119-121 Coalway Road, Wolverhampton, WV3 7NA Send response to journal: Re: Practising on the Poor?	This week’s analysis articles (“What should you do when you see a fellow student behaving inappropriately”) highlighted some of the many ethical issues surrounding medical student electives, particularly in the developing world. On my student elective in the Solomon Islands, I conducted a study that looked at healthcare workers’ beliefs about the role of medical students during their elective. (1) One of the main findings was that the majority of staff felt that medical students should be able to diagnose, treat and prescribe without direct supervision. However, they were not aware that students were not allowed these responsibilities at home. There appeared to be widespread lack of knowledge of medical education in developed countries. Thus students could easily "practise on the poor" by exceeding their normal role without the host institution realizing but with their full blessing. I would advocate that all host institutions should be made aware of the role of medical students in their home countries, and the objectives of the elective placement, so they can make informed decisions about the level of responsibility to give these students. This should preferably be done in advance by the home university, or otherwise laid out in a formal document sent with the student. It would help alleviate the moral dilemma faced by students expected to exceed their normal role, while giving the host institution autonomy about whether students can "practise" on their patients. (1) Radstone SJJ. Practising on the Poor? Healthcare workers' beliefs about the role of medical students during their elective. Med Ethics 2005; 31: 109- 110 Competing interests: None declared