Induction Checklist for GP placements

Welcome to the surgery

• Tour of the facilities at the practice
• Advise student of the named clinical and administrative lead and the contact details of the person they should contact in the case of illness or lateness
• Introduction to staff members. Consider providing a written list of staff and their role within the practice.
• Familiarisation with the physical setting - Availability of local shops for food/drinks
• Reminder of professional responsibilities including dress code, conduct, punctuality, name badge.
• Ensure that students are informed of any car parking restrictions.

Safety whilst on GP placement

• Named GP and administrative lead contact details with whom the student should raise concerns whilst on placement – these may include patient safety, student safety, student wellbeing, staff safety, harassment, undermining or bullying.
• The University raising concerns ALERT form link is now on the students e-portfolio to enable students and staff raise concerns directly with university.
• Advice to be given to students to include safety advice regarding the local area, Home visit safety (students not to attend home visits with GP supervision), panic alarm system.
• Ensure students have read “staying safe” section in GP student handbook.
• Location of safe place to leave coats, bags, bicycles etc, signposting to policies as below
• Health and Safety guidance and policies to include:
  
  • Panic alarm system
  • Infection Control
  • Raising concerns/whistleblowing/harassment/undermining/bullying policy
  • Confidentiality
  • Fire safety
  • Safeguarding
  • Chaperone policy
  • Complaints policy
  • Information adn data handling
  • Needle-stick/accident policy.
  • Please note - If a needle stick injury occurs, please manage as per local protocol and inform us via email: mbchb@liverpool.ac.uk.

Timetabling and meeting with GP tutor

• A timetable for the placement including expected times to arrive/ leave
• Induction to computer systems and record keeping IT, data management and information governance, including access to and basic training on the practice patient record system.
• Reminder about student obligations for confidentiality and consent for patients (Duties of a Doctor) including anonymising case histories.
• Initial meeting within the first week (ideally on the first or second day) with the GP tutor to discuss learning outcomes and aims for the placement. This should include timetabling, tutorials, arrangement for feedback to and from students, e-portfolio requirements, student wellbeing and raising concerns.

Despite the unprecedented change to our working practices due to the COVID-19 pandemic we still continue to provide excellent training to our student doctors in order to 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 student doctors remains to get them involved in any way that we can. Involving student doctors 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 consider the following:

• Pastoral Care – Student Doctors may have very different individual circumstances and concerns regarding COVID-19 and being on clinical placement. It may be useful to address this with each individual student doctor at the start of the placement. They will benefit from being clearly aware of who to speak to about any worries.
• PPE provision and practice procedures. Student Doctors will have been provided with PPE donning/doffing training by the University but you may wish to revisit this. Practices are responsible for providing adequate PPE to student doctors.
• 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. We acknowledge that most practices will not have dedicated changing facilities and as such lockable rooms such as toilets or internally lockable consulting rooms are acceptable.
• Student doctors should still sit in and observe consultations, including telephone and video consultations.
• If telephone consulting with a patient please ensure telephone consultations are audible to Student Doctors by using speakerphone and ensure consent is given by the patient
• Student doctors will still benefit enormously from being able to consult independently with patients. Telephone and video consultations are perfectly acceptable for student doctors to do independently with direct or indirect supervision from GP tutors.
• Both telephone and video consultations should be presented to the GP tutor and can be used by student doctors as Case Presentations and Discussions (CPADs) for their ePortfolio.
• Remote consultations will be new skills for student doctors, and they may benefit from direct supervision initially. They may 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.
• Student doctors 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 are still encouraged but avoid exposing student doctors to potential cases of COVID-19.
• Student doctors should still examine patients where possible and do still need to record Observed Examinations (OEs) for their ePortfolio.
• 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.
• Please also see the Home Visit section for further guidance on taking student doctors on visits during COVID 19

The information contained in this section related to pre-Covid Placements and supervision. For up to date information on changes to placement structure and Eportfolio requirements as a result of the Covid 19 pandemic please see the separate section titled 'Changes due to Covid 19' (link).

In 2019-20 academic year a pilot placement scheme was developed for one hundred of our Year 2 students to experience clinical placement in General Practice. This pilot ran for four out of a possible six Clinical Week blocks and provided Student Doctors with clinical experience in Primary Care in addition to their hospital based placements.  In the 2020 academic year we are planning to role this program out to 2/3rds of the Year for all six of the clinical weeks and the full year in 2021. Students are placed in pairs and attend for one clinical week in practice and the Clinical Weeks correspond to the Year 3 Academic Weeks making it possible for practices with Year 3 students to also host Year 2 student doctors if they wish.

Further information on these placements, along with the Year 2 handbook, will be provided on this page soon.

• Students attend the practice for 7 sessions a week for 4 weeks in Year 3 and 4.
• They are released from the practice on the same day each week to attend CCT teaching.
• The remaining half day away from practice is for the student’s personal learning and can be scheduled by the practice.
• Students may ask for this to be Wednesday afternoon in-line with other university activities, but this is up to the practice to decide.
• During their time in the practice student doctors should be involved in as much normal practice activity as possible. These should include Observing GPs, Nurses and other clinical staff, Consulting Independently, Home Visits, and specified Mandatory Experiences. It can also include Meetings, reviewing Laboratory Results, making referrals, Phlebotomy, Vaccinations, sitting with Reception. This list is not exhaustive, and we encourage practices to involve student doctors whenever possible.
• We recognise that every practice is unique and works differently to other practices, thus we accept that there must be a degree of flexibility in the structure of the student doctor’s time over their placement. However, the core course requirements that all student doctors should have on their placements are outlined in the section below.

Consulting independently

• 3-4 sessions each week should be spent consulting independently with patients, in pairs with one Student Doctor leading the consultation, preferably in their own room, with indirect supervision of a GP, subsequently presenting the cases to the GP. See FAQs (link) for more information.
• Consultations can be face-to-face, telephone, or video consultations. Each pair of Student Doctors should consult with a minimum of 12 patients per week on average over the placement, therefore seeing almost 50 patients over a 4-week block

Surgery observations

• 2-3 sessions sitting in and observing a GP surgery with the opportunity to become involved in clinical examinations and engage in case discussion as appropriate. This could occur in pairs or individually with different practitioners. If telephone consulting with a patient please ensure telephone consultations are audible to Student Doctors and ensure consent is given by the patient for Student Doctors to observe, just as you would for a face-to-face consultation.

Experience of the primary health care team

• 1 session with another health care professional – including Practice Nurses, GP trainees, Health Care Assistants, District Nurses, Community Midwife, Health Visitor, Community Physiotherapist or others as appropriate. This could occur in pairs or individually with different professionals.

Educational supervision

• The GP tutor will act as the student’s Educational Supervisor for their GP placement.
• Please visit the Educational Supervisor page (link) for more details.

Year 3 & 4 mandatory student experiences

These are essential activities that the Student Doctors must experience during the placement. They can occur in pairs or individually. They should be achievable within the 4 weeks of the placement as they are commonplace aspects of a practice’s daily and weekly activity.

Each should be followed by a debrief or discussion with a GP. This can be quite informal and may take place straight after the experience or during the weekly Educational Supervisor meetings. The discussion should help Student Doctors to reflect on the experience and direct their future learning. Their reflection will be documented in their e-portfolio (link).

For further details on these mandatory experiences please see the Year 3 GP Handbook 2021-22 (pdf) or Year 4 GP Handbook 2021-22 (pdf). Please be aware the experiences are different for each year group.

Each should be followed by a debrief or discussion with a GP. The discussion should help a student to reflect on the experience and direct their future learning. Their reflection will be documented in their eportfolio.

Home visits are a fundamental part of General Practice. They provide excellent learning opportunities for students to see how medical problems can affect the functionality and quality of life of a patient.

Incidents of violence or aggression are rare in the community.  However, visiting patients in their own homes as a lone student exposes them to the potential risk of injury due to a violent patient or relative/pet, or of injury whilst travelling in the community. Therefore, we request that students do not attend home visits on their own and are supervised by a GP tutor when attending a home visit.

Please consider whether the visit is suitable for a medical student. A number of factors increase the risk of home visits, including type of accommodation, locality, history of alcohol misuse, drug misuse or violence. Before every visit, the GP tutor/supervisor should ascertain the level of risk the medical student would be exposed to during the visit when deciding if the visit is appropriate for the student. The risk could be physical or psychological. High risk visits are not suitable for medical students.

Home Visits during the COVID-19 Pandemic

As we have seen a reduction in case numbers and serious illness resulting from COVID-19 we would now encourage you to take student doctors on home visits. However, this may be subject to change depending on the ongoing situation, in which case we will advise student doctors and placements accordingly.

We would ask you to undertake a “risk-assessment” of all home visits before taking student doctors on them. This does not need to be formally documented but should consider the following:

• Ensure student doctor has been regularly self-testing using Lateral Flow Tests
• Vaccination status of both patient and student doctor
• Potential risk to vulnerable patients due to extra persons entering their home
• Student doctors’ personal levels of health risk due to COVID-19 and their level of concern
• Risk of exposure to COVID-19 during the Home Visit. How likely is it that any of the patient’s symptoms could be due to COVID-19? Are any household members displaying symptoms of COVID-19? Student doctors should NOT be exposed to cases of COVID-19.

Once the above have been considered, patient consent must be obtained. This should be done before arriving at their home in order to ensure that patients do not feel pressurised to give consent.

Travel to and from the visit needs to be considered. If student doctors are travelling in a clinician’s vehicle then a suitable PPE facemask should be worn throughout travel. Consider whether social distancing guidelines can be properly observed e.g. distancing, minimising time within the vehicle and ensuring adequate ventilation. It may be appropriate for a student doctor to sit in the back seat of a vehicle or use their own transport where available.

Minimise time spent in the patient’s home and ensure distancing and ventilation guidance is observed.

• Student doctors attend the practice individually, or in pairs, for 7 sessions a week for 3 weeks.
• They are released from the practice on the same day each week to attend university-based teaching Community Clinical Teaching.
• The remaining half day away from practice is for personal learning and can be scheduled by the practice. Student doctors may ask for this to be Wednesday afternoon in-line with other university activities, but this is up to the practice to decide.
• During their time in the practice student doctors should be involved in as much normal practice activity as possible. These should include Observing GPs, Nurses and other clinical staff, Consulting Independently, Home Visits, and specified Mandatory Experiences. It can also include Meetings, reviewing Laboratory Results, making referrals, Phlebotomy, Vaccinations, sitting with Reception. This list is not exhaustive, and we encourage practices to involve student doctors whenever possible.

Consulting independently

• 3-4 sessions should be spent consulting independently with patients, leading the consultation, either in their own room or under observation from the GP tutor.
• Students should lead the consultation with a minimum of 12 patients per week on average over the placement, therefore seeing almost 50 patients over a 4 week block.

Surgery observations

2-3 sessions sitting in and observing a GP surgery with the opportunity to become involved in clinical examinations and engage in case discussion as appropriate. If telephone consulting with a patient please ensure telephone consultations are audible to student doctors and ensure consent is given by the patient for "student doctor"s to observe, just as you would for a face-to-face consultation.

Experience of the Primary Healthcare Team

1 session per week with another health care professional – including Practice Nurses, GP trainees, Health Care Assistants, District Nurses, Community Midwife, Health Visitor, Community Physiotherapist or others as appropriate.

Educational Supervision

• The GP tutor will act as the student’s Educational Supervisor for their GP placement.
• Please visit the Educational Supervisor Requirements (link) for more details.

Year 5 Mandatory Student Experiences

These are essential activities that the student doctors MUST experience during the placement. They should be achievable within the 3 weeks of the placement as they are commonplace aspects of a practice’s daily and weekly activity

Each should be followed by a debrief or discussion with a GP. This can be quite informal and may take place straight after the experience or during the weekly Educational Supervisor meetings. The discussion should help student doctors to reflect on the experience and direct their future learning. Their reflection will be documented in their e-portfolio. (link to Ed supervisor section).

For further details on these mandatory experiences please see the Year 5 GP Handbook 2021-22 (pdf).

The information contained in this section related to pre-Covid Placements and supervision. For up to date information on changes to placement structure and Eportfolio requirements as a result of the Covid 19 pandemic please see the separate section titled 'Changes due to Covid 19'

The Year 5 Community SAMP (Selective Advanced Medical Practice) is an optional placement in General Practice, Medical Education and University Based discussion groups. This offers students the opportunity to fully understand the role of a GP. They will also participate in teaching and discussion groups focussing on topical General Practice issues and have the opportunity to gain understanding of Medical Education principles and practice.

Students in the Community SAMP:

• Attend the practice for 6 sessions a week for 8 weeks.
• Are released from the practice on a Thursday each week to attend University based Community SAMP group sessions.
• Spend half a day per week in medical education. This will take the form of attendance at CCT teaching sessions every other week.
• The remaining half day is for the student’s personal learning and preparation for medical education sessions. This time should also be used to prepare their SAMP project and their Patient Journey project.

The information contained in this section related to pre-Covid Placements and supervision. For up to date information on changes to placement structure and Eportfolio requirements as a result of the Covid 19 pandemic please see the separate section titled 'Changes due to Covid 19'

Consulting independently

• The majority of sessions should be spent consulting independently with patients, leading the consultation, either in their own room or under observation/supervision from the GP tutor.
• Students are required to document a number of cases, adverse events and prepare a SAMP report and Patient Journey Project.
• For further information on the above requirements please see the Year 5 GP Handbook .

Surgery observations

Sitting in and observing a GP surgery with the opportunity to become involved in clinical examinations and engage in case discussion as appropriate.

Experience of the primary health care team

• 1 session with another health care professional – including Practice Nurses, GP trainees, Health Care Assistants, District Nurses, Community Midwife, Health Visitor, Community Physiotherapist or others as appropriate.

Home Visit Policy

Home visits are a fundamental part of General Practice. They provide excellent learning opportunities for students to see how medical problems can affect the functionality and quality of life of a patient.

Incidents of violence or aggression are rare in the community.  However, visiting patients in their own homes as a lone student exposes them to the potential risk of injury due to a violent patient or relative/pet, or of injury whilst travelling in the community. Therefore we request that students do not attend home visits on their own and are supervised by a GP tutor when attending a home visit.

Please consider whether the visit is suitable for a medical student. A number of factors increase the risk of home visits, including type of accommodation, locality, history of alcohol misuse, drug misuse or violence. Before every visit, the GP tutor/supervisor should ascertain the level of risk the medical student would be exposed to during the visit when deciding if the visit is appropriate for the student. The risk could be physical or psychological. High risk visits are not suitable for medical students.

These are essential activities that the Student Doctors must experience during the placement. They can occur in pairs or individually. They should be achievable within the 4 weeks of the placement as they are commonplace aspects of a practice’s daily and weekly activity.

Each should be followed by a debrief or discussion with a GP. This can be quite informal and may take place straight after the experience or during the weekly Educational Supervisor meetings. The discussion should help Student Doctors to reflect on the experience and direct their future learning. Their reflection will be documented in their e-portfolio (link).

For further details on these mandatory experiences please see the year handbooks. Please be aware the experiences are different for each year group.

• Year 3 GP Handbook 2021-22 (pdf)
• Year 4 GP Handbook 2021-22 (pdf)
• Year 5 GP Handbook 2021-22 (pdf)

Each should be followed by a debrief or discussion with a GP. The discussion should help a student to reflect on the experience and direct their future learning. Their reflection will be documented in their eportfolio.

The GP Curriculum Learning Outcomes are over-arching and are to be achieved fully during the clinical years.  They will be attained both through experiences in Community Placements and during CCT sessions.

The attached handbooks contain the current learning outcomes for each year group. The information contained is only for use with University of Liverpool, School of Medicine Students and must not be shared outside of this purpose.

Please attach link to the Year 2,3,4,5 and SAMP handbooks

• Year 3 GP Handbook 2021-22 (pdf)
• Year 4 GP Handbook 2021-22 (pdf)
• Year 5 GP Handbook 2021-22 (pdf)
• Year 5 SAMP handbook (pdf) 

Please let us know if a Student Doctor misses a session, even if it has been pre-arranged or for illness.

Send absence reports for Year 3 Student Doctors to Rachael Carr: yr3gp.mbchb@liverpool.ac.uk

Send absence reports for Year 4 Student Doctors to Chris Johnson: yr4gp.mbchb @liverpool.ac.uk

Send absence reports for Year 5/SAMP Student Doctors to Vanesa Ahmetaj: yr5gp.mbchb @liverpool.ac.uk