Ethical Challenges in Short-Term Global Health Training

Later, Jasmine is asked to perform a procedure that exceeds her level of training. What should she do?

CASE 3: Exceeding Level of Training

Vignette 2: After discussing this situation with her local supervisor and with her advisor at her home institution, everyone agrees that Jasmine should correct patients if they call her "doctor."  Jasmine remains concerned, however, that she might be performing some tasks that she is not ready for and certainly would not be permitted to do at home. For example, she was asked on numerous occasions to draw blood from patients without supervision; while trained in this skill at home, she did not yet feel “competent.”  On another occasion, she was asked to drain fluid from around a patient’s lung (a procedure called thoracentesis); however, she had never been trained how to do this procedure.

Jasmine is understandably nervous and upset when these situations arise. Which of the following statements represents sound advice for Jasmine when she is asked to perform tasks with which she is not yet comfortable?

If Jasmine feels uncomfortable with a task, she has a responsibility to at least ask for assistance and supervision.
This answer is correct. Jasmine at least has the responsibility to ask for assistance and supervision. She should also communicate her lack of experience to the patients she sees.
Jasmine should perform no task for which she does not feel 100% competent – even if it is a blood draw.
If Jasmine were to hold herself to this standard, she will gain little from her experience, and she is also unlikely to be able to help the local community as much as she otherwise could. In this case, Jasmine has been trained in drawing blood, but not in thoracentesis. Even if she is nervous, it might be reasonable for her to attempt the former, but not the latter. Choose a different answer.
Jasmine is a guest, and the hospital is critically understaffed. She should try to perform any task she is asked to do.
This is too permissive, and places Jasmine at risk of harming her patients or even herself. She should not learn additional procedures at the expense of the local patients. Often it is difficult to say no in a critically understaffed setting, but the onus should not be on trainees alone to do so. Choose a different answer.
So long as local medical students do it, Jasmine should feel comfortable doing so.
Unless Jasmine has requisite training, this is an unreliable guide for her action. Other locales might have different training programs and standards for their medical students. Jasmine should focus on her own abilities and competencies, not those of her peers in the local community. 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)