Guidance on undergraduate clinical placements

Medical students should feel part of the team

20. During a placement

  • Staff and placement providers should make sure leadership teams are accessible to students and value their contributions. They should make sure engaged and positive leadership is the norm across all grades and specialities. This helps prevent cultures of blame or outsider dynamics forming.
  • Placement providers should give frequent, direct and honest feedback to students. They should adopt a learning focused culture when mistakes happen and implement strategies for inclusion that counter insider/outsider groupings and hierarchies.
  • Placement providers and clinical teams should recognise that students are valued members of the team. They play an important role in supporting patient care.
  • Placement providers should make sure students are protected to learn safely within clinical environments. They should receive the same level of protection as other members of the clinical team. This is particularly important during a pandemic or crisis. For example, when appropriate students should receive the same protective clothing (PPE), training for doffing and donning as the other members of the clinical team. Students should comply with the policies of placement providers during these times.
  • Members of the clinical team should act as role models for students. They should conduct themselves professionally at all times. The team should build a good culture and healthy learning environment for students. Students should have the opportunity to observe compassionate clinical leadership and empathetic, safe patient care.
  • Clinical teams should always involve students in all clinical activities and observations. This can range from participation, assisting or leading depending on the competencies of the student. There should be adequate supervision to make sure patients are safe. Students should have equal opportunities to be involved in clinical activities.
  • Clinical teams should give guidance for students on accessing, and working closely with, multidisciplinary clinical teams. Students should familiarise themselves with members of the clinical team and multidisciplinary teams attached to the department. Student should take every opportunity to learn from all members of the multidisciplinary team. This helps to foster interprofessional learning and teamworking.
  • Students should be encouraged to use their experience on clinical placement to help develop time management and professional judgement skills. While it's important to learn theoretical knowledge, students should understand that experiential learning in clinical placements is fundamental. They should take every opportunity to be involved in day-to-day clinical activities. Equally students should be empowered to pursue learning through other means, such as self-study, lectures and webinars. This should happen when there are fewer clinical activities available for productive learning during the placement.
  • Placement providers should support the professional socialisation of students as it is key to professional development. For example, regular reflective practice and discussions with peers and teachers.
  • Clinical teachers should be involved in the assessment of the professionalism of students. This includes:
    • observation
    • case-based discussions
    • the use of electronic/paper portfolios (which show an ongoing record of personal and professional development) that promote critical reflection in authentic clinical settings with face-to-face review (that can be virtual).
  • Placement providers should support the specialist lecture/teaching programme of medical schools.
  • This includes:
    • the coordination of the schedules of the teaching programmes at both the medical school and placement provider
    • quality assurance of teaching content at the placement provider to match school curriculum
    • access of lectures for students on placements far from their medical school including IT services
    • standardised assessments.
  • Clinical placement teams should engage students in all forms of clinical governance activities with educational value. They should encourage students to recognise the importance and benefits of these activities.
  • Placement providers should adequately support students by giving them the time and resources they need to be involved in activities such as:
    • performing full cycle quality improvement projects or audits
    • participating in clinical research
    • teaching activities including departmental teaching, peer teaching and interprofessional teaching
    • preparing and presenting in governance meetings. For example, morbidity and mortality meetings and multidisciplinary meetings
    • engaging with senior management team
    • learning about how the NHS functions.
  • Placement providers should work with medical schools to consider the diverse needs of students. For example, reasonable adjustments, allowing time to observe faith and supporting those with caring responsibilities.

21. Experience in a hospital setting

Hospital placement providers should:

  • give students a good exposure of a healthcare environment. Students should learn how secondary and tertiary care contribute to the patient experience
  • make sure students gain experience of a diverse group of patients
  • give students opportunities to build on compassionate leadership skills. Examples of activities under supervision are:
    • assigning patients to students who will coordinate care from admission until discharge
    • lead in aspects of ward round
    • lead in departmental handover
    • organise and participate in multidisciplinary team meetings
    • attend departmental, division, directorate and network meetings.
  • provide students the opportunity to have hands-on experience of clinical activities. This should be under appropriate supervision and according to their level of competence. With appropriate supervision, and within the bounds of their competence, students should be encouraged to:
    • carry out procedures in accordance with Practical skills and procedures. The development of procedural skills may be best facilitated through scheduled sessions with allied health professionals. This includes (but is not limited to) phlebotomists, nurses and healthcare assistants
    • assist in surgical procedures or more advanced practical skills and procedures
    • carry out consultations with patients during face to face, telephone or video consultations
    • formulate management plans for patients including treatments and medications
    • make referrals and communicate with other medical specialties and members of the multidisciplinary team
    • keep accurate and concise patient records.
  • provide both scheduled and opportunistic bedside teaching to students. Clinical teachers should always consider students' level of understanding and learning objectives to make sure the teaching is relevant to them.
  • actively engage with the students when they're attending specialist clinics or observing complex clinical procedures. They should make sure the student understands the specialist area.
  • provide opportunities for students to meet different multidisciplinary team members. This helps the student understand different roles in the patient journey and fosters teamworking. This can be done by shadowing or participating in clinical activities such as:
    • shadowing nurses during drug rounds and observation rounds
    • shadowing pharmacists to learn good practice in prescribing
    • shadow other members of the multidisciplinary team, for example healthcare assistants, physician associates, anaesthesia associates, physiotherapists, occupational therapists, advanced nurse practitioners, dieticians, speech and language therapists.
  • provide students with learning opportunities in other departments which students are not directly attached to. For example, radiology services or laboratory services.
  • encourage students to attend out of hours clinical activities to maximise their learning opportunities. For example, night shifts and weekends. Students should recognise the value of experiential learning by working out of hours. Clinical teams should facilitate students' learning during both working hours and out of hours. Students who can perform out of hours activities should be given enough notice of out of hours clinical activities. Out of hours activities should not exceed expectations of a doctor in training. Placement providers should offer adequate rest time and provide appropriate rest facilities, especially for those working out of hours.

22. Experience in a GP setting

GP placement providers should:

  • give students a:
    • structured induction
    • a clear timetable of activities
    • opportunities for active participation, and
    • review and feedback throughout their placements.
  • actively support the development of students' clinical and communication skills. This includes observation and feedback.
  • provide access to a diverse range of professional role models.
  • encourage understanding of medical generalism and the guiding principles of general practice (person-centred care, population centred care and organisational aspects of primary care within the NHS or HSC).
  • provide opportunities to follow patients with chronic illness or multimorbidity through their journey, including:
    • the medical and social aspects of management
    • the impact of illness on daily living and those close to them
    • interaction with community services.
  • make sure students gain experience of a diverse group of patients.
  • promote understanding of primary and secondary care interactions. For example, for the referral and discharge processes, students can be encouraged to write referrals. This should include relevant supporting information and an understanding of red flag features.
  • support learning around service management and clinical leadership. For example, encourage attendance at practice meetings and local network meetings.
  • promote students' understanding of academic and scholarly aspects of general practice. For example, participating in:
    • clinical audit and quality improvement projects
    • primary care research
    • medical education projects
    • peer teaching.
  • promote skills in all aspects of consulting with patients. For example, face to face, telephone and video consultations. This should include the importance of concise and accurate record keeping.
  • provide opportunities for students to run clinics under supervision and in accordance with their competence.
  • encourage understanding of the population health role of primary care. For example, in relation to social determinants of health, health promotion and illness prevention.

23. Experience in a third sector/community setting

  • The curriculum should be inclusive and represent the values and needs of our diverse patient and student population. Medical schools should give all students a range of experience in third sector/social care/community settings that go beyond traditional hospital and GP placements.
  • Such placements should provide students with greater understanding of the social determinants of health and the importance of equality, diversity and inclusion in healthcare systems.
  • Active community engagement and outreach work should be encouraged. For example, visits to:
    • public health departments
    • community-based health services
    • homeless shelters
    • prisons
    • charities
    • disability centres
    • care homes
    • day centres
    • hospices.
  • Students at all stages should be encouraged to take up opportunities to engage in local public health, third sector and community initiatives where this is possible.
  • Placement providers should get informed consent from patients and service users when speaking to students or being observed.

24. Interactions with patients and those close to them

  • Students should always respect patient dignity and confidentiality. Students should approach all communication with patients with sensitivity and empathy. They should maintain professionalism when dealing with patients and those close to them.
  • Students should feel comfortable communicating with patients of a variety of demographics. This includes different:
    • ethnicity
    • gender
    • age
    • socio-economic background
    • disabilities
    • non-native English speakers.
  • During interactions with patients and those close to them, students should learn about a patient's experience and journey, especially from patients who have a chronic disease. This is in addition to history taking, clinical examination and pathologies. This familiarises students with providing holistic medicine and understanding social determinants of health.
  • Students should be encouraged to familiarise themselves with the varying disease presentations in different groups, different modes of disease management for different groups and different experiences that may occur in certain groups, recognising that determinants of disease are intersectional.
  • Clinical teams should empower students to provide health promotion advice. They should make sure students consider how health promotion advice might help reduce health inequalities. This should include promoting lifestyle changes. For example, quitting smoking, avoiding substance misuse and maintaining a healthy weight through exercise and diet.

25. Medical electives

Medical electives play an important role in student experience in clinical years. Students may choose to have medical electives abroad or locally. They might choose a clinical setting or other health organisations. For example, in public health or global health.

  • Medical schools should make sure students who participate in medical electives are supported throughout. However, they should also acknowledge that the same levels of support or type of intervention may not be available on elective, especially when abroad.
  • Students should use this opportunity to pursue a special interest which they haven't much exposure to in clinical placements.
  • Medical electives planned by students should have educational value and be in line with the medical school's curriculum.
  • Students doing medical electives in a clinical setting should always show professionalism.
  • Students doing medical electives should always ensure their safety and that of the patient. They shouldn't work outside of their competence.