Ethical Challenges in Short-Term Global Health Training
Jasmine is a third year medical student in a short-term training program in Central America.  Here she examines a patient (who calls her "doctor") and reports her findings to her local supervisor. Click image to play video.

CASE 3: Exceeding Level of Training

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Vignette 1: Jasmine is a third year medical student spending one month in a training program in Central America. Shortly after her arrival, she learns that the resident she was to work under will be away for the next week. Her local supervisor suggests that this will be a great opportunity for her to practice independently and to be in the "the real world." After all, it’s an understaffed hospital in a rural setting. Jasmine has just finished seeing a patient, and attempts to discuss her diagnosis with her supervisor.

Because she is a medical student, Jasmine is wrestling with her role and responsibility in this Central American hospital. This case raises a host of ethical issues. Let’s examine a few.

The patient called Jasmine "doctor," and Jasmine did not correct him. Do you think Jasmine should have explained that she is a student, and not a full doctor?

No. This happens even in developed countries, so Jasmine has no reason to correct the patient.
Although this same scenario might occur even in Jasmine’s home country, representing herself as being at a higher level of competence than she has actually attained is considered inappropriate in both settings. In the present context, her patient could be particularly vulnerable to this misperception as a result of her foreign status. Choose a different answer.
No. Her local supervisor wants her to diagnose and treat patients independently, so in fact, Jasmine IS acting as the patient’s doctor.
The fact that Jasmine is performing tasks a physician would perform in this setting does not justify her misrepresenting herself. In addition, some health care staff in developing countries believe that medical students do perform this way at home – even when they do not. Thus, her supervisor could be mistaken. Choose a different answer.
Yes. Jasmine is not a doctor. Respecting this patient requires that he be aware of her level of training and competence.
This is the best answer. Even though Jasmine is not in her home setting, she should represent herself truthfully that she is not a doctor.
None of the above. Jasmine should ask her local supervisor. If he wants her to represent herself as a doctor, then she should. If not, she should not.
Respecting the wishes of her local supervisor is very important, as Jasmine is a guest for this training experience. Nonetheless, she should be very cautious about misrepresenting herself in this manner. Choose a different answer.
© Stanford University Center for Global Health and the Johns Hopkins University Berman Institute of Bioethics.

Project funding provided by Doris Duke Charitable Foundation (DDCF)