Challenges and Innovations in Remote Placements for Medical Students

Problem

Keele University Medical School prides itself on its Early Clinical Placements in Primary Care Scheme for years 1 and 2 medical students. These placements are usually in-situ giving students early clinical exposure, with student-patient encounters having an educational rather than clinical focus.

Our team showed innovation and adaptability to deliver the ECPPC despite facing considerable obstacles due to the COVID-19 pandemic. This included safety considerations of patient's students and clinicians, equity of experience for students, teaching practice recruitment and retention issues and developing an online format and resources at short notice with constantly changing governmental guidelines.

Approach

In order to maintain the safety of all parties concerned, clinical placements were converted into an online format whereby students had a video encounter with a GP tutor in practice and a patient for an educational encounter using online platforms. After the programme had been developed, the Medical Schools Council and GMC subsequently published guidance (1,2), which aligned with the AGP Keele team placement vision.

As the pandemic progressed, further lockdowns meant students were told to leave campus and return home. Many teaching practices withdrew due to workload and workforce pressures. This posed new difficulties maintaining equity of student experience, patient confidentiality and sustainability of placements. Remote placement tutorials were created in order to remedy these issues. In this innovative format students reviewed pre-reading materials and a playlist of pre-recorded patient consultations from the Virtual Primary Care Website (3). Consultation analysis with a clinical facilitator formed the basis of the tutorial, following student ‘break out room’ discussions.

The remote format allowed recruitment of practices further afield and those who traditionally lack room capacity, making delivery of remote clinical placements more sustainable than their in-situ counterparts.

Findings

This scheme continues to develop but has proved effective in being able to find placements for all students despite multiple setbacks and fulfil the teaching requirements for years 1 and 2 Undergraduate Medical Students. Informal feedback has been and will be gathered throughout the year. After the initial pilot of year 1 and 2 remote placements/ tutorials, both students and GP tutors generally felt these were an engaging, interactive and effective teaching tool. The team is also undertaking a pilot to include more clinical consultations in the remote programme, in partnership with a local longstanding GP teaching practice. A more formal evaluation will be completed at the end of the academic year.

Consequences

The overwhelmingly positive informal feedback and ability to deliver remote primary care placements and tutorials has massive implications for the future. It provides a sustainable way forward for recruitment of practices, mobilising a greater pool of practices geographically, whilst maintaining safety and providing an equitable and high standard of teaching for students.