Quality of placements

1. There should be a person or team based at the placement provider responsible for organising the clinical placement. This should happen in conjunction with the medical school. The medical school lead or team should communicate with the departmental lead and supervisors for the placement. They should make sure the teams are aware of the details of the placement.
2. Medical schools should make sure all placements are adequately resourced for all settings. They should be mindful of requirement 5.4 in Promoting excellence and the requirement highlighted in theme 1 of the Promoting excellence: equality and diversity considerations.
3. All placements should have clearly defined learning outcomes. These should be linked to those set out in Outcomes for graduates. These learning outcomes should be communicated to those responsible for delivering teaching in the placement. Their individual roles in helping students to achieve the outcomes should be clearly defined.
4. Medical schools should make sure clinical placement providers are aware of the learning outcomes required for each placement. This includes the knowledge, skills and behaviours students will need to acquire in order to complete their logbooks.
5. Medical schools should give students clear guidance on what responsibilities they can expect to have on a placement. They should outline the duties students will be asked to carry out. If any reasonable adjustments are needed, these should be addressed in advance. Before they start, all students should have time to review the placement setting and duties.
6. Medical schools must give details about students to the person or team based at the placement provider responsible for organising the clinical placement. For example, their level of competence. These details should be passed to the supervisors and should happen well in advance of the placement. Supervisors are then responsible for passing on this information to individual clinical team members to allow effective organisation of teaching opportunities, clinical activities and supervision for the students.
7. Medical schools should offer students continual training and support during placements. Key topics include:
• harassment, including micro-aggressions, ally-ship and being a bystander
• mental health support
• discrimination
• speaking up. A raising concerns policy should be shared with students before or at the start of the placement. It should be quality assured and regularly evaluated by medical schools.
8. Our report Caring for doctors Caring for patients describes how medical schools should work collaboratively with students to:
• get feedback to meet their specific needs
• offer confidential services tailored to the needs of students
• make sure students have an effective way to feedback and speak up about concerns, eg bullying and undermining.

It is clear that clinical placements are an area of particular difficulty for medical students in terms of witnessing or being the subject of discriminating behaviour. The points below are some actions medical schools can consider to improve the quality of placements for students from all backgrounds. There is further guidance from the Medical Schools Council as detailed in their framework Active inclusion: Challenging exclusions in medical education.

1. Medical schools should understand and address equality, diversity and inclusion challenges. They must anticipate rather than react to student's diverse needs.
2. Medical schools and placement providers should create an inclusive culture and fair training environment at placements. They should respect different values, beliefs and perspectives.
3. When medical schools arrange placements for students, they should;
• consider the student's culture or religious values and how to respect them in different areas of practice. Students should be given guidance or policies before the placement. For example, dress code or religious observance
• be aware of any specific requirements the student has for their placement. The placement provider should be told about this
• remember their obligations under the Equality Act 2010. There must be no unfair discrimination on the grounds of religion or belief, age, sex or gender, marriage and civil partnership, race, sexual orientation and disability as they organise clinical placements
• take action to actively prevent and address racial harassment. There are recommendations in the BMA's Racial harassment charter for medical schools. Medical schools should make sure that robust reporting measures are in place but expand the coverage, so it is inclusive for all students who have protected characteristics.
4. Medical schools should make reasonable adjustments for students with disabilities. They should have the same placement opportunities as other students. Refer to Chapter 3 of our Welcomed and valued guidance – What is expected of medical education organisations and employers.

Organisations must take positive steps to make sure disabled learners can fully take part in education and other benefits, facilities and services. This includes:

• anticipating needs of disabled learners
• avoiding substantial disadvantage for disabled learners
• thinking again if an adjustment has not been effective.
5. Placement providers should make sure students are protected from discrimination, abuse or violence, as they would for any NHS or HSC staff members. If students experience discrimination, they should have support available. Actions to prevent and address discrimination should be documented.
6. If the placement provider has an equality and diversity officer, the student should be given their contact details. Medical schools should make sure agreements with placement providers are consistent with Promoting excellence: equality and diversity considerations.

1. Medical schools should make sure there is enough capacity for learning on clinical placements, and students can meet their learning outcomes.
2. Medical schools, allied health professions trainers and placement providers should consider new ways to deliver placements. For example, combining clinical placements for medical students with other health profession students. This increases learning opportunities between these professions. Or running placements in the third sector if funding is available.
3. Medical schools should make sure placement providers are well prepared to receive students. They should work with other schools to address issues like capacity where placements overlap geographically.
4. Placement providers should plan sessions, so all students are given equivalent learning opportunities. This is especially important when a large number of students attend a placement.
5. Medical schools should make sure that all students have access to planned teaching sessions and lectures. The location of the placement shouldn't affect this. Students should receive the standardised level of teaching to meet the curriculum.

1. Medical schools should be aware of points R5.3 (b) and (d) in Promoting excellence: standards for medical education and training. It says students should experience a variety of settings, specialties and patient groups within areas servicing diverse communities.
2. Medical schools should make sure students experience a variety of placements. For example, urban and rural, tertiary and district general hospitals, and community and third sector settings.
3. Medical schools should balance an increasing variety of placements (which can mean shorter placements) with longitudinal placements. This gives students a better understanding of the patient journey. It also gives them time to integrate into the clinical team.
4. Medical schools should provide students with clinical placements and direct patient contact in the early years of the programme.
5. Medical schools should work with placement providers in general practice and hospitals. This helps students understand the patient journey from primary care to secondary care and then to community and social care.
6. Medical schools and placement providers should make sure students can recognise and know how to manage acute mental health issues in all patients. For example, eating disorders or a mental health crisis.

1. Medical schools should have formal, written agreements with all placement providers. This should cover the provision of education and training to provide students with the knowledge, skills and behaviours as set out in Outcomes for graduates. They should have systems and processes to monitor the quality of teaching, support, facilities and learning opportunities on placements. These agreements should be easily accessible. For example, on the school's intranet.
2. The process for the allocation of financial resources for undergraduate medical education varies across the four countries of the UK. Medical schools will be aware of the processes in their own areas and should keep up to date with any developments or changes in the way that funding is allocated. Placement providers in NHS, Health and Social Care (HSC) system in Northern Ireland, and non-NHS settings should be adequately funded to carry out high quality clinical placements.
3. The agreement should clearly state who at the medical school is responsible for coordinating clinical placements for their students. These individuals should be available as a point of contact for placement providers if there's a problem with a placement. The agreement should state who is responsible for organising clinical placements at the placement provider. If placements are across more than one site, the medical school should have a named individual who is responsible for clinical placements for students at each site.
4. Agreements between medical schools and placement providers should set out a process for raising concerns. For example, about the way the placement is being run, the content of the placement or the behaviour/conduct of the supervisors and students. The agreement should contain a clear series of steps for raising a concern and explain the appropriate action to address the situation.
5. Agreements between medical schools and placement providers should state clearly how students can access pastoral care and be supported throughout their clinical placement. This should include supporting students with mitigating circumstances, personal life challenges, wellbeing issues and students speaking up on issues such as bullying and harassment.
6. There should be regular feedback and communication between the medical school and placement providers about the quality and delivery of placements. Placement providers should participate in medical school quality assurance programmes, support data collection, and review relevant actions from the medical school's student placement evaluation.
7. Medical schools should consider whether their agreement with placement providers allows them to effectively quality manage placements. These processes should identify any concerns about individual placements. Any concerns identified should be discussed with the placement provider. The agreement for that placement could be amended with extra provisions which rectify the concerns. If there isn’t enough improvement, the medical school should suspend placements to that provider and make alternative provision.
8. Medical schools should make sure their agreements with placement providers are consistent with their equality, diversity and inclusion action plans and policies.
9. Medical schools should consider including the following details in their agreements with placement providers for all settings:
• Expectations around induction processes for students
• details of clinical supervision with consultants and senior medical staff. This should include duration, frequency, teaching activities and opportunities
• timetable for students detailing formal teaching episodes and experiential teaching opportunities and locations. Timetables should be given to students as soon as possible so they can prepare
• student access and training for the placement providers' IT systems, patient information, ward access cards, library and journal access and simulation
• information about medical school processes for the management of concerns about student progress, conduct, or wellbeing. This should include information about how placement providers should notify the medical school about any concern
• information about the medical school policy on student leave and attendance, and details of the agreement with placement providers to support accurate recording and regular reporting of student leave and attendance
• emphasis of the importance of students being integrated into clinical teams, obtaining clinical and practical experience and a range of working hours. For example, out of hours such as night shifts and weekends. Medical schools may want to list the experiences and practical procedures they want students to carry out during each clinical placement
• agreement between the medical schools and placement provider for regular, centralised teaching available to all students while completing each placement in addition to bedside teaching. The agreement should state who is responsible for delivering the centralised teaching
• clarification on indemnity cover for students if they are under the supervision of an independent contractor
• details about the Director of Medical Education, or equivalent, representation at Board level within the placement provider
• details about how funding for education is visible and accounted for at Board level within the placement provider
• arrangements for regular non-clinical time for private study so students can consolidate their learning on clinical placements.

1. Placement providers should monitor the diversity of the cohort of clinical placement supervisors. They should make sure there is appropriate representation, considering both the diversity of the clinical workforce and the student cohort.
2. Placement providers should comply with our requirements around the recognition and approval of trainers.
3. Performance of supervisors should be regularly reviewed and appraised (Standards 4.1 and 4.2 in Promoting excellence).
4. The development of a student on a placement should be overseen by a named educational supervisor (although job titles may vary). The expectations of a named educational supervisor are detailed in paragraphs 60–65 of our Leadership and management for all doctors.
5. Each student should have a named clinical supervisor who oversees a student's clinical work throughout a placement.
6. Different grades of doctors and senior healthcare professionals can provide different levels of supervision for students.
• Consultants and GPs should be the doctors who have overall clinical responsibility for the supervision of students. They can make informed judgements on the day-to-day supervision that a student needs. This is based on the previous experience of that student and the types of tasks they may have to complete.
• Specialty trainees, and specialty and associate specialty (SAS) doctors can support students by providing educational and coaching opportunities. Along with registered senior healthcare professionals they can provide supervision to students where the named educational or clinical supervisor has approved for them to do so.
• Doctors in Foundation Year 1 (F1) and Foundation Year 2 (F2) can oversee students in carrying out simple tasks but they shouldn't have overall responsibility for supervision of the student. F1 and F2 doctors should act in this limited capacity only where they are fully competent to carry out the task they're observing themselves. Other registered healthcare professionals, for example advanced nurse practitioners (ANPs) can observe the work of students in a similar way to an F1 or F2 doctor.
7. In a third sector setting, students can be supervised by a registered senior allied healthcare professional. They should have oversight of the placement setting and how the educational needs of students can be met.
8. All those responsible for supervising, coaching or overseeing students should be trained, supported and briefed to carry out this role.
9. Medical schools should make sure students know to stop work immediately if they're concerned about supervision. For example, if they aren't receiving enough supervision and are working beyond their level of competency. Concerns should be fed back to their named clinical supervisor and their medical school.
10. Medical schools should also make sure students know to immediately talk to their named clinical supervisor if they believe they may have acted inappropriately. Or if they have any reason to think a complaint may be made about them by a patient.
11. Schools and placement providers should empower students to feedback to them on poor supervision in confidence.
12. All supervisors should be engaged with teaching. They should make sure service delivery and competition from others receiving training doesn't deflect from the education of students.
13. Named educational and clinical supervisors should:
• be made aware of the details of the students they will be supervising before they arrive on placement. This information should be sent from the medical school to the person or team based at the placement provider responsible for organising the clinical placement
• show respect for diversity and difference in their interaction with medical students
• provide an inclusive and compassionate placement environment for the students
• be made aware of the learning objectives and skills expected for each of the students they are supervising in all settings. This information should be sent from the medical school to the to the person or team based at the placement provider responsible for organising the clinical placement
• make sure students are introduced to all members of the clinical team who they will be working with
• make sure all students receive an appropriate and fair breadth of experience
• receive the resources, time and support to allow them to fulfil their educational and training responsibilities as per standard 4.2 and requirement 4.3 from Promoting excellence
• give students the chance to get the most out of their placement experience and not just meet service need. For example, allowing students personal study time if there aren't many learning opportunities at that time
• be understanding of personal and academic commitments which may fall within the duration of the placement, in line with medical school policy and student professionalism.

1. Remote consultations are now embedded in routine NHS clinical practice in primary and secondary care practise. Medical students should expect to be part of remote consultations during their placements and placement providers should make sure to accommodate this experience if applicable. If undertaken in line with the good practice guidance outlined below, they are a valuable learning experience
2. Students should receive inductions specific to remote consultations which should include, but not be limited to:
• information governance and security, including the use of the placements' remote consultation software
• deciding when a remote consultation is appropriate
• getting consent in remote consultations
• confidentiality in remote consultations
• the principles of remote prescribing, referring to Good practice in prescribing and managing medicines and devices.
3. Medical schools and students should consider following MSC's guidance on students attending remote consultations.

1. Medical schools should evaluate how effective their clinical placements are, including the delivery of the set learning objectives. This may include:
• the quality and quantity of teaching, supervision and feedback on the placement
• the availability of resources, such as libraries and IT systems
• the personal support available to students on that placement, bearing in mind that some groups may need more support than others
• the ability of students with specific requirements, for example a disability, to access resources and learning opportunities
• the overall fairness of experiences on placement of different groups of students across a range of equality, diversity and inclusion indicators.
2. Medical schools should be aware that many placement providers will have internal quality assurance processes. They may be able to use these to evaluate the quality of their clinical placements. Additionally, schools should share appropriate data with the placement provider for use in the placement providers' quality management processes. This would be subject to legislation on the correct use of personal data.
3. Effective evaluation can take many forms. Two or more data sources could be used to triangulate the data and produce an accurate evaluation of the quality of the placement. Stability of the data can be assessed by longitudinal studies.
4. Some suggestions for how schools can collect data for evaluation include:
• surveying students
• analysing the portfolios or logbooks used by students on the placement
• surveying clinical supervisors and those who have been involved in delivering the placement
• getting the views of former students who are now F1s
• getting the views of non-medical staff who have been involved in delivering the placement
• getting the views of patients where appropriate, including those involved in teaching and assessing students
• analysing the amount of time dedicated to teaching in the job plans of consultants and other doctors involved in teaching
• use of focus groups.
5. There should be a feedback mechanism which includes input from students, both named and anonymised.
6. Feedback and evaluation of students' performance should be an active and continuous process throughout the clinical placement. Students and all members of the clinical team should proactively seek and give feedback.
7. The named educational and clinical supervisor should actively collect feedback from the team members to gain an insight of students' progress. Students should be signed off by a named educational supervisor who has an insight of students' progress.