Medical students should feel prepared supported and safe
11. Preparing students
- Medical schools should make sure students:
- are aware of the learning outcomes of each placement
- are aware of a placement timetable and learning activities
- are aware of conduct and behaviour policies of the placement provider
- know they are present in an employment environment and the need to behave as if they are employees
- are aware of how they can seek support to meet their needs and specifically how they make a case for reasonable adjustments
- are aware of how to raise concerns in the clinical environment and the steps involved
- are given information on social media policies before they start their first placement by their medical school. Students should be aware of our guidance on social media use
- have been offered the appropriate training (including training that covers IT systems they will need to use) and given appropriate resources to carry out their placement.
- Medical schools and placement providers should make sure students have good access to accessible and flexible IT resources to meet the needs of virtual learning while on placement.
- Medical schools should use simulation training and inter-professional learning to help prepare students for real life scenarios they'll encounter in their placement.
- Processes should be in place to ensure confidentiality and allow a safe environment for students to learn from their mistakes.
- Placement providers should be encouraged to identify a mentor or establish a 'buddy' system, pairing senior students to junior students. A 'buddy' can advise on learning opportunities and other related issues in clinical placement. Within this, placement providers should consider the diversity of the buddy system.
12. Induction into placements
- Medical schools should make sure all students receive induction into placements. The requirement for induction should be part of their agreements with placement providers.
- Medical schools should also consider the specific induction needs of individual students. They should make sure reasonable adjustments are made to address these.
- Induction should be given by all placement providers and should include the following elements:
- the protocols, rules and procedures specific to that placement
- the context of practice in that locality, organisation and community. This includes an overview on the diversity of the patients they will see and the health inequalities in the surrounding area
- information about appropriate conduct and behaviour. For example, dress codes, good time keeping, reporting sickness absence, and treating patients and visitors with respect
- information about health and safety rules
- information about the importance of students looking after their own health. For example, recognising when their health could mean it's inappropriate for them to attend a placement
- roles and responsibilities in the team
- familiarisation with the physical setting and layout of the placement environment
- introduction of the student to relevant staff members, including levels of supervision and lines of accountability
- access to wellbeing, peer support and staff networks
- how to raise concerns, particularly around patient care and the level of support and supervision provided
- learning objectives
- schedule for learning activities
- access to clinical and learning resources including records and IT systems as appropriate
- how students will receive feedback on performance and how to respond
- Medical schools should balance induction content to prevent repetition, information overload and student fatigue. A general element of induction should be offered centrally. Specific elements should be offered at the relevant placement providers.
13. Personal protective equipment (PPE)
- Medical schools should make sure students receive training in all aspects of infection prevention and control (IPC), appropriate to the placement type.
- Placement providers should make sure training includes putting on and taking off PPE for all students on placement.
- Placement providers should be aware that some students are unable to use alcohol-based hand gels. These students will require additional access to handwashing facilities.
- Placement providers should be aware that some students are unable to wear certain PPE. For example, religious head coverings mean a respirator can't be worn. They should provide alternative, but equally effective, protective equipment such as hoods appropriate to the placement requirements.
- Medical schools and placement providers should routinely monitor and support the wellbeing of their students.
- Placement providers should make sure students have access to facilities that contribute to their wellbeing during a placement. For example, food, hydration, a private place for mothers to express milk, toilets and rest areas, especially for long or out of hours shifts.
- Placement providers should make sure students have access to facilities to observe their faith. This should include appropriate breaks.
- Placement providers should make sure students receive adequate breaks during long or out of hours shifts.
- Medical school and placement providers should recognise that students will face challenging clinical and communication scenarios. For example, witnessing death or breaking bad news. This can affect students' mental health and wellbeing. Medical schools should provide tailored psychological support for students. Students should be supported to develop a set of mental health coping mechanisms. For example, reflection, debriefing, handing over to another colleague, peer support and asking for help.
- Medical schools should make sure students completing a placement away from home get support in adapting to their environment. They should have access to all learning and wellbeing resources, including local support mechanism like peer support networks and diverse staff networks.
- Medical schools should offer support for costs incurred for attending remote placements. For example, travel costs if a placement is an unreasonable distance from the student's residence.
- Medical schools should make sure that, if there are a variety of placement locations, the method for allocating students is fair and transparent. No groups should be disadvantaged or unfairly treated.
- Medical schools should offer specific support and reasonable adjustments to those with childcare or caring responsibilities.
15. Speaking up
- Students should be empowered to speak up about any concerns. This can include safety and behavioural issues that affect themselves or others. Students should be able to do this openly, anonymously or confidentially. Their choice should be respected. In cases where complete anonymity is not possible, medical schools and placement providers should take extra effort to safeguard these students.
- Placement providers should make sure students are aware of the local speaking up policy. They should know the internal and external routes for raising issues or suggesting improvements. In England, students should be made aware of the role of the Freedom to Speak Up Guardian as an additional source of support. This can be used if they aren't able to escalate their concerns through the designated pathway locally.
- Medical schools and placement providers should work together to make sure students know how to raise issues of bullying, harassment and undermining. They should effectively resolve any issues which are raised.
- Medical schools and placement providers should make sure students who speak up are protected against any repercussion, victimisation or discrimination.
- If concerns are raised about a supervisor or supervisors (or other relevant professionals at the placement provider), the individual/s should be informed of the concern and remediation allowed. If remediation is not successful, it may be possible to agree with the individual that he or she will no longer act as a named educational supervisor or named clinical supervisor. If agreement is not possible, the placement provider should speak to the student's medical school. It may be necessary to prevent the supervisor from acting in a specific role. Or to remove them from the database of recognised trainers. Further information can be found in Recognising and approving trainers: the implementation plan.
- Agreements between medical schools and placement providers should set out a process for raising concerns. For example, concerns about the quality of the placement or the engagement of individuals. The agreement should contain a clear series of steps through which concerns of the school or the placement provider can be raised. It should explain how these issues will be handled. When issues are raised that may impact on individuals, medical schools and placement providers should always consider appropriate support and protection that may be required.
16. Sexual misconduct
Power-imbalances can mean students don't feel able to speak up about sexual misconduct. It might also impact on the trust others have in the impartiality of the educator to deliver a fair and inclusive learning environment. Local cultures will also have a significant impact. If sexual banter is tolerated in an environment, it can be even harder for an individual to speak up. This undermines trust and respect, which can gradually impact on patient safety.
- Placement providers, as employers with responsible officers, have clear roles in identifying and managing sexual misconduct. This includes a doctor's alleged sexual harassment and abuse of colleagues, including students, within and outside medicine.
- If students report sexual misconduct, the placement provider and medical school should be in contact. For example, inappropriate sexual remarks, persistence in asking for social engagement clearly directed to them as individuals, and unwelcome physical contact. Complaints must be taken seriously.
- Medical schools should make sure procedures are clearly signposted on placements and inform students how to report misconduct. Information should be easily accessible, clear and give confidence that reporting misconduct won't impact their education.
- Placement providers should make sure local policies addressing different aspects of sexual misconduct are up to date. They should be well publicised to raise awareness among employees and students. It should be known that all incidents are taken seriously.
- Placement providers should make sure local polices don't create additional barriers to reporting, such as those highlighted in the 1752 group report Silencing students: Institutional responses to staff sexual misconduct in UK higher education.
- Alongside their own support services, medical schools should also signpost students to independent third-party services for supporting.
- All members of a medical team have a professional responsibility to report all incidents they are aware of. Placement providers should remind supervisors of this responsibility.
17. Consensual relationships
- Medical schools and placement providers should work together to develop robust consensual relationship guidelines or agreements. These should be in line with Good medical practice.
- Students should follow the consensual relationship policy of their medical school while they are on placement.
- Supervisors (or other professionals present on placement) and students should not be involved in a romantic or sexual relationship with each other during a clinical placement.
- If a prior relationship exists between a student and supervisor (or other professionals present on placement), it's both the student and supervisor's responsibility to report to their line manager or medical school. The student should then be relocated to another team.
18. Return to medical school and mitigating circumstances
- Students returning to medical school after extended time away should be offered additional support. For example, if they have been unwell or have been intercalating. This will help to make sure they're prepared for starting a clinical placement. Support could include simulation training of skills or resilience training. Where appropriate medical schools should refer to our guidance Welcomed and valued.
- Medical schools should offer confidential services tailored to the needs of students. There should be a package of support for those seeking mitigating circumstances or needing to take time out from their course. This should include additional ways to complete attendance and curriculum requirements.
19. Information technology (IT)
- Medical schools should make sure their students are aware that they're subject to the same obligations as other staff. This includes confidentiality and patients' consent to the use of their health records while on placement. Students may need access to their placement provider's IT systems to carry out their placement objectives effectively.
- During an assistantship, students should be able to access IT systems to gain a realistic experience of patient care, including electronic record keeping and prescribing.
- Medical schools should make sure their agreements with placement providers cover students' use of IT systems. The agreement should:
- include clear guidance on who is responsible for making sure the student understands and follows the rules and procedures for IT use in that placement
- enable safe student access, appropriate data protection and confidentiality.