Improve practice income and morale by hosting medical undergraduates

Medical students are a growth industry. Numbers are up and more medical schools are looking to increase their students’ exposure to primary care.

Hosting undergraduate medical students in your practice can bring many benefits. It brings variety to the working day, stimulates learning and even boosts morale through students’ enthusiasm for the most routine of patient contacts.

As a profession we need to produce a generation of doctors willing to take up the baton of primary care. One of the best ways to achieve this is to give our students a positive experience of general practice. Students come with certain challenges, but careful planning can address most of these.

Funding

There is some variability in the funding available, but in general practices receive around £500 per week to host a full-time student for five days a week. Occasionally students might have some central teaching during the week and the total will be reduced to reflect this – around £50 per half day. Payments are made by the medical schools and fees are consistent across their practices – there is no room for negotiation.

Depending on the institution, there may be limited facilities funding for new practices to help prepare for the arrival of students. This is usually a one-off payment – it is certainly worth enquiring about the availability of this when approaching a medical school.

If you are more than an hour’s journey from a medical school, then accommodation may be required for students during their attachment. Funding is usually available for this, although this is unlikely to be enough for five star luxury. Local B&Bs, budget hotels or rented rooms can be used, but you will need to be guided by the specific requirements of the medical school. Wi-fi and a desk are seen as essentials.

What’s expected

You will be provided with a contract which lays out the minimum requirements of the medical school. This will usually list the facilities that must be provided and is likely to be very similar to that required for GP training, however it is not necessary to be a postgraduate training practice to take students.

The contract should also specify the number of attachments you will be expected to provide, requirements around student assessments and the amount of time the students should be in the practice.   

Some medical schools send students from different years into primary care. If so, they should provide course books or curricular documents to enable you to adjust your offering to meet the requirements of students at different stages of their training.

Placements very in length and all medical schools do this differently. For example, the University of Leicester sends students out for three 12-week blocks a year, while Cambridge University will send students for varied lengths of attachment depending on the year of study, between 2-6 weeks per attachment. Practices should contact the relevant medical school directly to get a handle on this.

Finding the students

Medical schools prefer to send students to local practices if possible, but with increasing intakes, some have had to look farther afield. Consider your nearest medical school if you are close to a University, but also look at medical schools within an hour’s journey from your practice.

In addition, you may have nearby schools that have recently undergone expansion or new medical schools in the area that are keen to forge new links with local training practices. These are the schools most likely to be looking for new placements, although most primary care departments would be happy to be approached by practices keen to get involved.

Ask colleagues from existing teaching practices how they started and for any contacts they may have. Alternatively, check the medical school website for appropriate email addresses (usually through the Department of Primary Care).

Getting signed up

After initial enquiries, the school will usually arrange a site visit. This is an opportunity for you to ask questions and for them to ensure your facilities are up to scratch. Requirements vary from school to school, but in general, students need access to the internet, preferably Wi-Fi, a quiet place to study and a place to have a coffee and eat lunch. Depending on how the placement is organised, they may also need their own consulting room for some or all of their attachment.

Students will require an assessment at the end of their placement and the site visit is a good time to find out how much work is required for this. In general, medical schools provide training for their clinical tutors with regular CPD opportunities.

After the visit, there is a chance for both parties to decide whether to proceed further. The academic year runs from late August to early July, and medical schools like to have all their placements organised before the summer if possible. A well-timed e-mail or phone call can speed up the process if a school is short of practices.

Providing a positive placement experience

Keeping the students happy is key to a successful placement. In student feedback, there are four themes that crop up regularly: being made to feel welcome, having an organised timetable, lots of exposure to patients and feeling valued.

Some tips for creating a mutually beneficial environment for students:

1. Make sure all members of the practice know when students are coming.
2. Circulate their photos and names around all staff and encourage everyone to help them settle in. Just having their name remembered is seen as a big plus for students used to being swallowed up in the anonymity of busy hospitals.
3. Nominate a lead administrator to organise the student timetable and act as a point of contact for any queries.
4. Include an induction period, but get the students in front of patients as soon as possible. Sitting in a corner observing others consult can be interesting for a day or two, but will soon become boring if it takes up the lion’s share of a placement.
5. If students do need to sit in with you, keep them on their toes by asking questions, demonstrating clinical signs and explaining management plans.
6. Get the students involved in quality improvement activities – for example helping with audits or working with patients on lifestyle improvement projects. Students love to feel they may have made a difference to a patient’s life and many of these activities can benefit the practice too.

Impact on workload

It is likely that you will lose some appointments to teaching surgeries and any tutorials run by GPs.

Some schools allow students to see patients in a parallel room, before presenting the case to a supervising GP. If permitted, this is a good way to minimise appointment losses.

You will also need to offer direct observation of student consultations from time to time. Specialist nurses or other allied health professionals can be used for tutorials if they have a particular interest.

What financial benefits are there?

The traditional model of hosting medical students is not especially lucrative. By the time lost appointments are added up, you will probably just about break even if you are taking one student at a time. Economies of scale can be achieved by hosting more students, however – for example, by enabling you to offer group tutorials.

If permitted by the medical school, consider sharing some of the teaching with neighbouring practices. Try to be creative when thinking about your rotas – splitting morning and afternoon surgeries can allow you to increase student numbers without having a negative effect on quality.

Giving students time with allied health professionals or local voluntary organisations can help to reduce the burden on GP appointments. Ask your medical school if any other practices take larger numbers of students and find out what methods they have used.

Softer benefits

The current climate in the NHS means working in general practice can be a grind. Bringing medical students into an environment where staff are already working at their limit may seem counter-intuitive.

However, the enthusiasm of future doctors can feel like a breath of fresh air and help you to understand why you got into this game in the first place. Seeing a student’s face light up when they hear a heart murmur for the first time, or seeing their pride at diagnosing otitis media correctly may well be the highlight of your week.

Dr Andrew Ward is a GP Partner and Group Lead for Education, Lakeside Healthcare and Senior Clinical Educator, Leicester Medical School