Guidance on undergraduate clinical placements
26. Student assistantships
- Medical schools should be confident that students are adequately prepared to take on the increased responsibility involved in an assistantship. This is shown by satisfactory coverage of Outcomes for graduates. Students shouldn’t progress to an assistantship if there are concerns about this.
- Where possible, schools should try to put students in an assistantship in the same location as their first F1 placement. For students where this isn’t possible, a period of shadowing before they begin their F1 post is advised.
- Medical schools and placement providers should prepare students for the reality of working in a clinical environment.
- Medical schools and placement providers should give support and advice if students encounter difficult clinical and ethical issues.
- Medical schools and placement providers should prepare students on the following before they start an assistantship:
Students should have a designated doctor in training (preferably an F1 doctor) during assistantship to shadow and assist
Students should maintain a good standard of professionalism which includes:
- safe working practices: handwashing, infection control, occupational health information, health and safety in the workplace
- safe prescribing policy
- how to access IT support
- working hours and working patterns
- rotas and controls over hours worked (in light of the Working Time Regulations)
- good time management skills and how to prioritise tasks
- how and when to take a break
- safe handover arrangements
- coping with working during winter pressures and crisis situations
- understanding learning outcomes
- portfolio preparation and completion
- development of clinical competences within curriculum progression
- career patterns and pathways
- local NHS or HSC structures
- hospital hierarchy and ward or clinic arrangements
- national NHS or HSC structures and commissioning arrangements
- careers advice and the importance of research and lifelong learning
- support structures available such as Doctors in Difficulty policies, the Guardian of safe working and the British Medical Association.
- protecting patient confidentiality
- working in a multidisciplinary team
- treating colleagues, patients and visitors with courtesy and respect.
- A student assistantship isn’t defined by its length or the specialty the student is working in. It’s defined by what the student does and learns during their assistantship and how this period of time helps to prepare that student for practice.
- Students should be fully integrated within a clinical team. They should be on the rota for that team and should have a defined role and responsibilities.
- Students should participate in activities like those of a newly qualified doctor. This is subject to patient safety and consent, and legal requirements. Examples of tasks students should carry out while on their student assistantship include:
Student assistantships should have clear learning outcomes relating to the tasks they are asked to perform. These outcomes should be communicated to those at the placement provider who organise and supervise assistantships. It’s the responsibility of medical schools to set the outcomes for individual placements, but the areas they should consider for assistantships include:
- clerking patients in hospitals and consulting with patients in general practices under supervision
- managing acutely unwell patients under supervision
- carrying out practical procedures on patients under supervision. These could include procedures as set out in Outcomes for graduates – Practical skills and procedures
- helping F1s to make referrals to other specialties and order investigations whenever appropriate
- prioritising patients and completing tasks generated
- managing patients’ paperwork such as medical notes and discharge summaries. Medical notes, checked by a doctor, can form the basis of the patient record
- making recommendations for the prescription of drugs to real patients. This could take the form of producing duplicate ‘dummy’ prescriptions. The student then gets feedback from a registered doctor or pharmacist.
Medical schools should consider discussing with placement providers whether their governance procedures will allow students to write up actual prescriptions. This can be supervised by a registered doctor who checks and signs them. This key skill prepares students for practice after qualifying.
Students on assistantships should be prepared to give patient care to a level similar to that of an F1 doctor. This includes working on calls, out of hours and learning to manage workload due to winter pressures or crisis situations. However, this should not impact on their experience or learning during the assistantship. Students shouldn’t be required to work extra shifts due to service pressure.
Students should be given the same protection as qualified doctors in terms of rest time and commute time after out of hours shifts. This should also include time needed in between changing placements in another location. Students should be given rest and commute time to prepare for next placement.
Placement providers and medical schools should consider the safety of students when arranging out of hours shifts. This includes providing an appropriate rest area or accommodation, and the availability of transport.
- complex communication skills, for example breaking bad news
- prioritising a complex workload
- understanding and applying legal and ethical considerations
- understanding the operation of the NHS or HSC
- knowledge of prescribing.
28. Feedback and evaluation
- Feedback on a student’s performance during an assistantship should follow the same principles as a clinical placement.
- Feedback should mainly be given on a student’s performance by the named educational and clinical supervisor. The rest of the clinical and non-clinical team should also provide feedback.
- F1s should be empowered to give constructive feedback to reflect the true picture of a student’s performance.
- Student evaluation of their experience should form a significant part of the overall evaluation of an assistantship.
- Medical schools should understand the issues around indemnity relating to students in clinical placements. They should make sure placement providers know how indemnity applies to student assistantships.
- Statements from the relevant bodies in England, Northern Ireland, Scotland and Wales are available in the Annex to this document. They confirm that where students are working under the supervision of an NHS or HSC employee, they will be covered by NHS/HSC Indemnity. Where a student is working under the supervision of an independent contractor GP (a GP who is not employed by the health service) the student will need to be included in the contractor’s own indemnity cover. Or arrange their own full indemnity cover.
- Accordingly, medical schools should make sure students in an assistantship with an independent contractor, are covered by their indemnity. This should be clearly signposted in the agreement with the independent placement provider.
- Medical schools may also consider whether their students should be members of a medical defence organisation when they are doing assistantships. They can often provide advice on the type of cover required.
- Shadowing should be provided to all graduates before they start Foundation Year 1, it is an important part of a medical student’s preparedness for practice. Shadowing is organised by the UK Foundation Programme Office.
- Graduates should be properly prepared for their first allocated F1 post. After their assistantship, they should have a period working with the F1 who is in the post they will take up when they start F1.
- This shadowing period allows graduates to become familiar with the facilities available and working environment. They also learn their working patterns and get to know colleagues. It also provides them with an opportunity to develop working relationships with the clinical and educational supervisors they’ll work with in the future.
- It should be protected time with tasks that let graduates use their medical knowledge and expertise in a working environment. It should be different from the general induction sessions provided for new employees and Foundation Programme trainees.
- The shadowing period should normally last at least one week. It should happen as close to the point of employment as possible.