COVID-19: returning to clinical placements

We set out our approach to resuming clinical placements and provide guidelines on what you might want to consider if you are a student returning to a clinical placement following the pandemic. 

Location: UK
Audience: Medical students Medical academics All doctors
Updated: Wednesday 9 September 2020

As steps are taken to return to a more ‘normal’ way of life, you may be cautious about resuming placements.

The BMA wants to ensure that:

  • progression through the degree programmes proceed as planned
  • the adverse impacts of delays to progression are avoided
  • learning opportunities are maximised
  • students are able to continue with studies and placements safely, with risks to personal and public health minimised.

You can read our full statement on returning to clinical placements.

If you have read the below and require support, please email us at [email protected].

 

Issues to be addressed before placements start

The following are the key issues that we believe need to be addressed before placements start.

  1. Robust supervision and teaching arrangements need to be in place.
  2. Risk assessment is critically important, and needs to be done in advance.
  3. Access to PPE (personal protective equipment) appropriate to the clinical setting, but without affecting availability for other healthcare workers, is essential. Furthermore, thorough training in its use must be provided.
  4. Information about wellbeing support, ranging from mentoring through to access to childcare, needs to be provided for medical students.

Solutions to these key issues need to be jointly agreed and monitored by medical schools and placement providers. This must account for any local lockdowns, as placements may be impacted.

 

Availability of PPE

You can expect NHS trusts, GP practices or anyone else undertaking clinical teaching to take all reasonable care to protect students from risk of contracting coronavirus.

Students are under no obligation to place themselves in situations where they are exposed to unreasonable risk in order to be educated and/or to participate in care for patients.

If you are concerned for your safety

If there is an unresolved concern you have expressed, it may be necessary for your employer to offer leave of absence (which may extend beyond one academic year) until the risk has passed. If this is the case, then you will have to continue to have access to ongoing constructive support.

PPE requirements

Medical students should be provided with the level of PPE appropriate for the clinical setting they are in according to PHE guidance. The risk assessment for this is not the responsibility of the student.

The PPE that is provided should be in line with our PPE guidance, taking into consideration equality implications, to account for concerns around fit or communication:

  • FFP3 masks must be made available for those who must retain beards/facial hair for religious reasons
  • appropriate PPE for those who wear headscarves for religious reasons
  • transparent face masks must be provided for those that rely on lip-reading/facial cues.

It is important to recognise that patients or other doctors may need transparent face masks too.

Before starting the placement, you should be trained in the use of the PPE, including how to don (put on) and doff (take off) this equipment.

Part of the training involves understanding that the risk of you transmitting infection to others is as important as you not being exposed to infection from others, and how to minimise those risks.

 

Supervision of students

Your primary or secondary care setting supervisor may be based either within the placement provider or at the medical school.

Supervision must be overseen by a fully registered doctor with a licence to practice. They must determine and provide what is required either personally or by arranging for one or more competent healthcare practitioners to supervise you.

 

Wellbeing

International students

We know that international students have concerns about how the return to placements will affect you. If you have an existing tier 4 visa issued for the duration of your course, this should cover you for the duration of any extension due to your graduation date being pushed back. You may want to reach out to your medical school for reassurance about this.

Students who are members of the BMA can access the BMA’s immigration advice service for free initial advice with any subsequent advice at a discounted rate.

 

Students with childcare considerations

Many medical students will have lost access to childcare during the outbreak. Childcare settings are unlikely to reopen instantly, and informal care will take longer to become available.

If you are a medical student with childcare responsibilities and it may be difficult to resume clinical placement at this time, you should get in touch with your medical school to discuss what support is available to you.

 

Isolating and your household

Students on clinical placements should be assessed as they may be isolating, vulnerable or high-risk or living with people who are. Special measures need to be put in place for vulnerable or high-risk students, and may even require leave of absence, during which it is important that your support structures are maintained.

There are disabled students that do not fall within one of the categories of those considered particularly vulnerable to COVID-19, or may have been shielding. These students will require specific support needs and will have statutory rights to reasonable adjustments.

Self-isolation and local lockdown

There may also be situations where you may have to self-isolate after returning to placement – you may have contracted COVID-19 or there may have been a local outbreak.

This would require a conversation between you and your medical school, about the detail of your competencies and progression and whether the outcomes of the placement have been fulfilled or can be mitigated. The BMA will be able to support you through this process.

Increased exposure to COVID

Students will be required to travel to and from clinical settings, potentially placing themselves at greater risk of being exposed to COVID-19 than they would be had placements not resumed, either on public transport or lift sharing. This also has implications for the spread of the virus.

Placements need to be carefully monitored to ensure that the risk of contracting or spreading COVID-19 is as low as possible. This can be achieved by facilitating avoidance of public transport wherever possible, and by providing differential placement opportunities for those at higher risk, for example.

The BMA recommends that stability of clinical placements is ensured, and that students are not rotated rapidly between settings, to minimise the potential spread of the virus between them.