Working within your competence during your elective

The MDU’s medico-legal fellow Rachel Stewart offers tips on maintaining professionalism and being aware of your capabilities during your elective.

Your elective is an exciting time. You’ll have the opportunity to explore areas of medicine you may not have previously been exposed to, as well as different work environments, countries and maybe even cultures.

Whatever you decide to do and wherever you decide to go, it’s important to make sure you maintain the same level of professionalism and ethical standards you would while on placement at home. 

Ask for help when necessary (or say no)

Although electives are usually done towards the end of medical school (and you might have already finished your last exams), make sure you’re clear with colleagues and any patients you see during your elective that you’re still a medical student, as opposed to a doctor. 

Even when this is clear, healthcare professionals might not be aware of the expected duties and capabilities of a final year medical student from the UK compared to the country you are in. It’s possible that a misunderstanding about this could lead to you being asked to do tasks where you feel out of your depth. 

You may feel obliged, especially if the hospital or clinic you’re in is short-staffed, to keep quiet and carry on. But the GMC’s guidance for medical students is clear: students must recognise the limits of their competence and ask for help when necessary. It goes on to say that students should make sure that they “clearly explain their level of competence to anyone who supervises you on a placement, so you are not asked to do anything you are not trained to do.”

It can feel awkward or unhelpful to decline a request. This may be best done by making it clear that you’re keen to help, but to explain that you don’t have the required experience to do what they have asked. You might wish to ask whether it’s possible for the person making the request to show you how to perform the task or to supervise you doing it, depending on the situation and your experience. 

If you find that you’re consistently being asked to perform duties beyond your competence, or are not being appropriately supervised, then you may wish to speak to your elective supervisor in the first instance. If your concerns remain unresolved then you should contact your medical school to make them aware of the issues, and to make contingency plans if you cannot continue your elective safely. 

As an MDU member, you can also contact us for advice 24/7, 365 days of the year.

Maintain confidentiality and ask for consent

When you see an exciting case, or a condition that’s uncommon in the UK, it’s natural to want to find out more. You may think it’s useful to share with other students when you return home. However, your duty of confidentiality applies to all patients regardless of where in the world you see them. 

If you want to take a photograph of a patient for use in a presentation or other educational material, then you must make sure you have appropriate consent to do so. This applies whether or not they are identifiable. It might also be important to consider whether a translator is required when seeking consent from patients whose first language is not English to ensure they’re fully informed. It’s vital that you do not share the photo beyond the scope of the original consent.

You should also be cautious around posting on social media about the clinical aspects of your elective. Even if an individual post (for example, about an exciting day in theatre assisting with a complex procedure) doesn’t identify a patient, be aware that snippets of information from serial posts by yourself, or by combining your own and other student’s posts, might.

Be honest and act with integrity

While you should make the most of the opportunity to travel abroad, the purpose of your elective is to gain healthcare experience in another setting, and this usually means that your university will require you to complete a certain length of placement. 

It may be appealing to take up an offer to be signed off a week or two early so that you can spend more time exploring with colleagues, but you should only end your elective placement early with appropriate authorisation and confirmation from your medical school. 

Additionally, it’s important that any sign-off accurately represents the length and nature of your elective as misleading your medical school about this is likely to be seen as dishonest. Doctors are expected to be honest and trustworthy to maintain the public’s confidence in the profession, even as a medical student, and any suggestion that this is not the case might raise concerns about a student’s fitness to practise. 

Electives can be invaluable in consolidating your medical knowledge. But always be mindful of GMC guidance and adhere to the same levels of confidentiality, consent, honesty and awareness of your competence that you would at your own medical school.

Want to write about your elective? Getting articles published is a useful addition to your e-portfolio and CV. Find out more about how to submit your article and share your story with fellow students.

This page was correct at publication on 04/04/2023. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Dr Rachel Stewart

by Dr Rachel Stewart

Rachel is a medico-legal fellow at the MDU, having previously worked as a clinical fellow in plastic, reconstructive and burns surgery. She graduated in 2019 from the University of Edinburgh, and it was during this time that her interest in law and medical ethics began, working as a committee member of the Medical Ethics and Humanities Society. She also enjoys teaching and mentoring, and is currently doing a part-time Master of Education degree in Surgical Education at Imperial College London.