This article applies the theoretical framework of principal-agent theory in order to better understand the complex organisational relationships emerging between entities invested in the establishment and monitoring of cross-border international branch campus medical schools. Using the key constructs of principal-agent theory, information asymmetry and goal conflict, the article explores the multiple information asymmetries and potential goal conflicts that exist in the establishment of branch campus medical programmes. A review of the literature on international medical programme oversights revealed several considerations for organisations to contemplate in the physical movement of their institutions across borders. Using examples drawn from Weill Medical College in Qatar and Newcastle University Medicine Malaysia, the article illustrates how multiple overlapping agencies can provoke information asymmetry regarding quality standards and conflict of goals between the branch campus and the accrediting agencies. In the cases of international branch campuses, differentiating the principal and the agent is often difficult.