Changes to GP Placements due to COVID-19

Despite the unprecedented change to our working practices we still need to continue to provide excellent training to our student doctors. In order ensure the next generation of doctors enter the workplace well prepared for the challenges they face.

The situation will continue to evolve and may again suddenly change in unexpected ways but the main principle of providing a good placement experience to our medical students will remain to get them involved in any way that we can.

Involving medical students in our daily working routines is always a valuable experience for them, whether that be telephone/online triage, telephone/video consulting, face-to-face appointments, ordering investigations and review of results, prescribing, practice meetings, change planning, significant event analysis or audit.

Please read on for additional guidance as to how to provide a quality clinical placement despite the changed nature of our work, the varied approaches between practices and the constantly evolving situation. This information should be used in conjunction with the existing GP Placement handbook.

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    Pre-placement preparation & Risk assessment

    To ensure the safety of students while on clinical placement all students will be asked to complete a health risk assessment by the University and you will be informed if the student placed at your practice falls into one of the high risk categories.

    For further details of this process and other important aspects of student safety please view the University's Risk Assessment for Placement of Student Doctors in General Practice (PDF). This file is password protected to ensure the form is only accessible for supervising GPs. 

    We would ask you to consider your individual practice circumstances, how they have changed, and how medical students will fit into this new situation. Please refer to the Risk Assessment for specific risks which need consideration. Please complete and return this form to caj@liverpool.ac.uk

    In addition to this document, from a practical point of view it may be useful for you to consider further questions in advance, such as:

    • How big are your consulting rooms? Will you be able to follow social distancing advice with students observing?
    • Do you have the necessary IT equipment for students to perform video consultations? Webcams or computers with integrated cameras will be needed. Many practices are using video systems which can utilise their mobile phones, but this will not be suitable for students due to personal data usage and confidentiality concerns.
    • How will you prepare your patients for interacting with students? What is your previous process for gaining consent and how will this need to change? How can you ensure that students see a wide range of cases?

     

    Induction

    Feedback from students consistently tells us that they want a good induction when on placement and this will be more important than ever. Please review your induction process/documents to take into account the following:

    • Student personal Risk Assessment - be sure to check that your student has completed a personal risk assessment with the University (See the Risk Assessment section above) and whether you have been notified of any issues, or if there are any concerns the student wishes to discuss.
    • Pastoral Care – students may have very different individual circumstances and concerns regarding COVID-19 and being on clinical placement. Students will benefit from being clearly aware of who to speak to about any worries.
    • PPE provision and practice procedures. Students will have been provided with PPE donning/doffing training by the University at the start of the academic year but you may wish to revisit this.
    • Where students can change and store their clothes/personal belongings as they will now be required to change into University scrubs upon arrival at the placement each day.
    • New triage and appointment systems.
    Consultations

    In line with the existing placement handbook, students should still sit in and observe consultations, including telephone and video consultations. Consider the use of the speakerphone to allow students to hear the full conversation. Patient consent must still be gained for a student to observe. Please try to involve the student where possible and discuss the cases with students to engage them in the process.

    Students will still benefit enormously from being able to consult independently with patients, although we recognise that opportunities will be significantly reduced due to changes in working practices. Telephone and video consultations are perfectly acceptable for students to do independently with direct or indirect supervision from GP tutors.

    These will be very new skills for students, and they may benefit from direct supervision initially. We aim to increase students’ awareness and provide training on these new methods of consulting prior to placements, as well as new online resources for students to supplement their placements.

    Both telephone and video consultations should be presented to the GP tutor and can be used by students as Case Presentations and Discussions (CPADs) for their Eportfolio. Students may struggle with the new ways of consulting and find it hard to know whether their consultations are of sufficient quality/depth to be used as a CPAD and they will require guidance on this.

    Students should be involved in telephone or online triage where possible – this is likely to remain in General Practice for the time being and student should gain experience with it. This should be directly supervised.

    Face-to face consultations with low-risk patients are still encouraged. Please consider both the patient’s and the student’s risk from the interaction e.g. avoid exposing a patient that is at high risk from COVID-19 (shielding) and do not expose the student to potential cases of COVID-19. Students should still examine patients where suitable and ideally do still need to record Observed Examinations (OEs) for their E-Portfolio although the requirement will be reduced (see below).

    Please consider how you will prepare your patients to have these consultations. Normally we would advocate gaining consent at the time of the patient booking the appointment. This will still be possible for routine appointments but may need a new process when students are involved in triage/more urgent care.

    Mandatory Experiences

    There are 4 Mandatory Experiences detailed in the handbook for each 4 week placement. While we are not removing these, we do recognise that some of these will be difficult to achieve.

    Therefore, the students’ E-Portfolio requirement will be reduced to any 2 out of the 4 experiences.

    In addition, what constitutes an “experience” will need to be more flexible. It will NOT be appropriate for students to attend home visits or visits to care homes for the time being (see below) but if a student is significantly involved in the process that takes place around a home visit that would be acceptable. For example - triaging a home visit, observing video consultation with a housebound or care home patient, planning or decision-making around a home visit, prescribing, writing a referral letter, observing MDT.

    There are now many online resources available to students which they can use to supplement their placement experience including the Mandatory Experiences and they should be directed to access these during their placements where appropriate.

    Informal Teaching

    Due to a greater proportion of telephone and video consulting there may be more opportunity for discussion around a patient when students are observing doctors or other healthcare professionals. We would encourage this and especially discussion of the impact of COVID-19 on the care of individual patients, decision-making process and patient-care as a whole.

    It would be very appropriate to discuss change in working practices, practice response to COVID-19, personal experiences, coping with uncertainty, managing a practice, impact on staff, local area demographics and local COVID-19 statistics.

    Home Visits

    Home visits will not be appropriate for students initially. The group of patients requiring visits are generally at greater risk from COVID-19 and therefore should not be exposed to increased risk of transmission of COVID-19 from students. As time goes on and the risk level changes this may be possible to change. We will issue guidance if this is the case.

    E-Portfolio Requirements

    Students still require regular Educational Supervisor meetings with their GP Tutor. There is no change to this requirement. We believe that these meetings will be even more important for students as they offer opportunities for support and clinical discussion to further our students’ progress.

    For changes to the E-Portfolio during COVID-19 please view E-Portfolio Requirements During COVID-19 (PDF). This file is password protected to ensure the form is only accessible for supervising GPs. 

    Student Wellbeing and Concerns

    Students may have quite different individual circumstances and concerns regarding COVID-19 and being on clinical placement. These may manifest in students experiencing difficulty, or performance issues such as absence or illness. Students will benefit from being clearly aware of who to speak to within the practice about any concerns they may have. They can also be signposted to University support services as follows:

    There are additional specialist services (including online) available depending on the student's specific needs. Further information is available to our student doctors via the University Student Support website, or you can direct Student Doctors to our School's Student Intranet.

    Practices should make sure they are aware of how to report any absences and concerns to the school - please refer to the GP Placement Handbook. This is always important but has never been more important in order that we can support any students in difficulty during what will be a challenging time for them to be on clinical placement.