Back to school: a roadmap for medical students returning to clinical placements

by Chris Smith

Medical students must benefit from timed supervision and teaching when they return to their studies

Location: UK
Published: Thursday 16 July 2020
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As many medical students across the UK head back to trusts, practices and hospitals for the resumption of clinical placements, the BMA has been working to ensure students can finish their degrees, avoiding disruption and delay as much as possible.

While we must get back to some degree of normality around our studies, the BMA medical students committee is clear that students must be safe when they return and that medical schools recognise the specific challenges we’re facing in the wake of COVID-19.

To this end, we’ve released a statement for medical schools and students. There are four issues MSC has identified as important before we restart. The first is that proper supervision and timetabled teaching must be provided from day one. Medical students cannot be expected to slot back into an environment that has drastically altered since we were pulled from our rotations in the spring.

We need a thoughtfully planned return taking into account all of the teaching and competencies missed, plus the rustiness we might be feeling from months away from the bedside. We need to know what we can do, what we’ll be taught and how we’ll be supervised to ensure we aren’t missing out on anything vital. If we aren’t afforded these basic requests then our learning will suffer. It would also be unfair on our qualified colleagues to have us back on the wards without clear objectives and appropriate arrangements that would allow us to be taught properly.

Secondly, all medical students must be risk-assessed in advance so that everyone is comfortable with what resuming a placement means for them individually. Prompt assessment before the restart is also important for ensuring that appropriate alternatives can be arranged where necessary.

PPE (personal protective equipment) has become a household acronym during this pandemic, and for good reason. Any situation where medical students were not provided with the correct PPE or training is unacceptable. It puts us in danger and, if not properly planned, the increased demand for students may put a strain on existing stocks that are reserved for healthcare workers.

The PPE must be fit for purpose, as defined by Public Health England. It should also be recognised that not all types of PPE are appropriate for every student, and different items must be provided if there are religious, personal or disability-related reasons that warrant bespoke solutions.

For students who have found this blog because they’re worried about PPE and want to know what they can do if they’re feeling unsafe, the BMA is clear that students are under no obligation – ethical or legal – to place themselves in situations where they are exposed to unreasonable risk when being educated and/or delivering care to patients. 

Several complex issues might initially arise from COVID-19 but can have far-reaching ramifications. What might begin as stress or uncertainty around one topic can easily become something more insidious for many students, especially when combined with the ‘normal’ rigours of studying medicine.

Medical student wellbeing is already something that we take extremely seriously, but there must be additional care and attention paid to our community as we return for the 2020/21 academic year.

There must be robust processes in place for students to raise concerns about their wellbeing and readily accessible student support services, and we call on medical schools to communicate with students regularly so that we’re kept up to date with what decisions are being made and why. This should not be a one-way conversation: medical students should be consulted and involved in the local decisions that affect them at all times.

When difficulties do arise for students, we must be supported and medical schools should be willing to work with students as the whole system readjusts to provide a COVID-disrupted training programme. For example, support for those requiring childcare, which is difficult and unpredictable even in normal times.

Issues such as local lockdowns and last-minute schedule changes might mean that students with children need to prioritise their families’ needs at short notice, resulting in occasional difficulty with attending clinical placements. Students should not be penalised unfairly for circumstances that are no fault of their own and schools should reach out with empathy and offer to make rearrangements where possible.

Another challenge is the extensive essential travel between hospitals, primary care facilities and other locations in the community while we’re gaining our clinical experience. This means that students will be exposed to different levels of local infection and restrictions on daily life.

As this happens, and if local outbreaks occur, it is paramount that students do not endanger themselves or the public when moving between placements or between their placement and home.

Medical schools should facilitate the avoidance of public transport wherever possible, and different placement opportunities must be available for students at higher risk due to medical conditions or other recognised risk factors. Students should not be moved too much at short notice to prevent the shuttling of COVID across the country.

All of this, and more, is covered in our statement for returning to clinical placements. As the government continues to fudge its guidelines and seemingly arbitrarily change its advice regularly, we hope this guidance will act as a reassuring point of reference for students who are excited, nervous or impatient to resume clinical placements.

The GMC, individual medical schools and the Medical Schools Council have been excellent partners of MSC during this unprecedented crisis. We’re committed to making sure that students will be safe, fulfilled and looked after as we return to medical school in the coming weeks.

We will be producing further guidance for students in due course.

Chris Smith is BMA medical students committee co-chair

Read the full statement