Frequently Asked Questions

Student Doctor-led clinics: First and foremost, we are very happy for you to be flexible in how you arrange the Student Doctor surgeries. If a spare consulting room is available for the student doctors to use, the model below minimises the impact on available appointments:

This allows for 15 face to face consultations including 4 Student Doctor consultations. Further consultations including telephone consultations could be added after this. Please note that we ask for Student Doctors to consult independently with 9-12 patients across 3-4 sessions each week. This therefore works out at 3-4 Student Doctor consultations per session.

If a spare consultation room is not available, then the following model might be used to allow adequate time for the students to lead on a consultation within the GP’s surgery:

The Student Doctors do not have to be directly supervised when seeing patients. Student Doctors greatly value the opportunity to see the patient on their own before presenting the case, usually in front of the patient. For the 3rd years, especially early on in the year, having their own clinic is a challenge, but they know every patient will be seen by the GP after them and we want to motivate and engage them as much as possible.

Observation clinics: It is important that Student Doctors have time to discuss cases and management plans and to examine patients in a supervised setting to get feedback on their clinical skills. We would recommend that in a 2 ½ hour GP surgery that at least three 10 minute slots are blocked to give time for this. This is particularly important where the student is not leading on any consultations, allowing time for teaching around the cases seen to occur.

The Student Doctors are all DBS checked, are given advice regarding staying safe and know the professional standards that are required. In general, Student Doctors will see patients in pairs. If for any reason there is only one Student Doctor present at the practice then they can see patients and examine them alone, although should be made aware of the practice chaperone policy. Student Doctors should never conduct intimate examinations unsupervised. Student Doctors should not conduct acute home visits unsupervised. However, it is appropriate for them to see pre-arranged patients with chronic diseases, either at the surgery or at home in pairs, if the GP tutor feels this is appropriate. Consulting with patients in this way enables the Student Doctors to learn about specific chronic diseases and address the learning outcomes of the placement.

Over the 3rd and 4th years of the MBChB course we want Student Doctors to develop from information-gatherers to a more active consulting style interpreting the information from their histories and examination findings to consider differential diagnoses, appropriate investigations and management plans. This will be a process over the 2 years and different Student Doctors will progress at different rates.

Student Doctors attending a GP practice early in 3rd year may need more guidance to begin this process, whereas we would hope Student Doctors attending towards the end of 4th year should be able to present their GP tutor with a concise case summary, a likely diagnosis and a safe and appropriate management plan.

Therefore, 5th year Student Doctors should be able to do the above from the start of the academic year and as they progress through 5th year we would expect that their skills in this area become more sophisticated, taking into account wider perspectives when forming a management plan.

Each practice works differently and thus how patients are booked into the Student Doctors’ appointments may vary, but patients must be aware that they are seeing a Student Doctor at the time of booking and again when they arrive for their appointment. This may mean that Student Doctor appointments are best managed directly by reception rather than online etc. It is useful to stress to patients that it will be a longer appointment, that they will see a Student Doctor first and then the GP will see them. It is still possible to have a mixture of pre-booked and urgent/on-the day patients for the Student Doctors.

Particularly in the early 3rd year placements, the Student Doctors will struggle with some of the complex cases that present in General Practice but equally some GP Tutors have reported that with patients who have very minor problems the Student Doctors sometimes do not know what to do (e.g. if it is ‘just an ear infection’ have they done an appropriate/comprehensive ENT exam or followed NICE guidance regarding assessment of a pyrexial child? If it ‘just a repeat of the pill’, have they done BP and discussed taking/missed pills/CIs etc?). It is important that Student Doctors see a mix of patients including acute presentations and follow up cases.

Changes to how GP surgeries work should be incorporated into Student Doctors’ experience on their placement. It can be very useful for Student Doctors to take an initial triage-style history from a patient before presenting it to a GP and discussing the management plan. The supervising GP should always make their own subsequent assessment of the patient, either by telephone, by bringing the patient into the practice, or home visit as appropriate. It is good learning for Student Doctors to be further involved in the assessment and management of patients that they “triage”.

This is a decision for each individual practice. They should be discouraged from writing copious notes during their consultations to ensure their attention is on the patient and they keep their history focussed. It can be helpful for Student Doctors to take a couple of minutes at the end of the consultation before their GP Tutor joins them to structure their thoughts, decide on the key facts they wish to present and consider their differential diagnosis and management plan – making brief appropriate notes on paper or on the computer system can help some Student Doctors with this process. If Student Doctors do make an entry in the notes then we would recommend that it is only in the form of freehand notes and not coded data. The supervising GP should always make their own entry in the notes after seeing the patient.

Student Doctors should be encouraged to be proactive during the middle of the day, reflecting on the cases they have seen, identifying their learning needs and addressing them via the various on-line resources available for them on via the University interactive portal. It would be appropriate for the Student Doctors to accompany GPs on home visits on at least some of the days they are at the practice or alternatively there may be appropriate patients with chronic diseases that the GP Tutor could arrange for them to visit (see previous guidance on home visits). Student Doctors should also be encouraged to prepare for afternoon consultations by reviewing patient notes in advance and this may help them to make the most of patient contacts.

Student Doctors should have access to the computer record for each patient they are seeing to help them prepare for the consultation. Whether they have their own individual log-in details (probably better for IG purposes) or a generic/locum log-in (probably easier to administer) is up to each individual practice.

The Student Doctors are still in training: they should not be regarded as competent in any procedure and must be supervised by a responsible clinician. They will have evidence in their e-portfolio of the procedures they have been taught in their clinical skills sessions. Student Doctors must also be directly supervised for all intimate examinations.

General practice provides a wealth of learning opportunities not always available in secondary care. Should there be a learning opportunity for a procedure which is not itemised in the clinical skills list the Student Doctor will be able to fill in additional DOPS forms to upload in their portfolio. We encourage Student Doctors to use the GP placement to practice clinical examination and clinical procedures.

Since 2017 all Student Doctors are provided with a medical scrub style uniform to wear while on placements. This is now mandatory for both primary and secondary care placements. Students are permitted to travel to and from placement in their scrubs provided the School logo is kept hidden during travel.

We will be pleased to consider applications for Honorary Lecturer status. GP Tutors must have hosted Student Doctors for at least 3 years, attended teaching events and successfully completed Quality Assurance visit requirements. The benefits of this title include general access to University facilities such as libraries, computing and sports facilities. In addition, you will receive various University publications and invitations to degree ceremonies. Please contact hlsclinicalhonorary@liverpool.ac.uk if you would like details of the application process.

For information on how to invoice the School of Medicine please see the GP Tutor Handbook for your year group. This can be found within the Primary Care section within Resources on LEO (link).