Background

James was a final-year medical student who had arranged a clinical elective in Cambodia. He had secured the placement through his uncle, who was an intensive care doctor working in the area.

He was excited at the opportunity to gain hands-on clinical experience but quickly realised that the hospital he was working in had low level of staffing and a very relaxed clinical governance. Due to these resource limitations, James was encouraged by local staff to assist with – and even carry out independently – procedures far beyond his level of training. These included inserting central intravenous lines, placing chest drains, and even attempting patient intubations.

Supervision was inconsistent, often informal, and reactive rather than proactive. James felt uneasy but was reassured that this was ‘standard practice’. He began to question whether he should continue participating in these procedures.

Allegations

On returning to the UK, James learned that a relative of one of the patients he treated overseas had contacted the General Medical Council (GMC) to raise a concern. The relative alleged that James had undertaken invasive procedures without having had adequate training or supervision, and this had put the patient’s safety at risk.

Following the complaint, the GMC opened an investigation into James’s conduct during his elective, looking at whether or not he had acted outside his professional scope of practice as a medical student.

How Medical Protection helped

Fortunately, James was a member of Medical Protection and had informed them about his elective placement before starting this role.  At that stage, an adviser had discussed the potential risks of overseas work and had reminded him of the GMC’s guidance regarding the scope of practice for medical students. He had been advised that during his elective, he should not be asked or expected to perform tasks outside his levels of competence.

When James contacted Medical Protection about the GMC investigation, he was assigned a dedicated expert team. A medicolegal consultant talked him through the process and helped him to pull together a portfolio of reflective practice and correspondence demonstrating his efforts to clarify his role while in Cambodia.

In addition, Medical Protection helped James open a GMC file and worked with him to gather supportive statements and timelines that demonstrated his intent to practise ethically and safely, even under difficult conditions.

Should the investigation have escalated to a tribunal hearing, Medical Protection could have provided medicolegal representation to ensure that James’s fitness to practise was not unfairly questioned.

Outcome

After completing a thorough review and completing their investigation, the GMC acknowledged that James had not acted with malicious intent and had been put in a difficult situation with limited oversight. However, the investigation did raise concerns about the blurred boundaries of his role as a student and his decision to go ahead with high-risk procedures beyond his levels of competence and without supervision.

The GMC decided not to take further action but issued James with formal advice to be more careful about any future electives and to always ensure he is clear on what his responsibilities are and his limitations when it comes to scope of practice.

Learning points

• Medical students must not perform clinical procedures beyond their training abroad, even if they encouraged to do so.
• When taking part in electives overseas, supervision and clearly defined duties are crucial.
• Medical Protection membership offers protection and advice in a range of scenarios, including in the event of a GMC investigation.
• Early advice can help students to avoid risky clinical situations and navigate unfamiliar healthcare systems.
• Having appropriate indemnity is essential in order to protect students on overseas electives from complaints, legal claims, and regulatory procedures.