On becoming a doctor

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Ganfyd does not yet have much information for those who wish to train as doctors, or on medical schools as such. You may wish to refer to the following web sites:

Contents

Screening and vaccination before starting at medical school

While in 1996 medical schools clearly interpreted the guidance in very different ways,[1] the guidance on this now seems to be fairly clear.

The Medical Schools Council (with others) issued guidance on this in 2008,[2] since endorsed by the GMC,[3] Dental Schools Council, and restated in 2010.[4] The guidance is based on guidance for all healthcare workers.[5]

The Medical Schools Council includes the following principles:

  1. Admission to medical school is not conditional on the results of blood borne virus (BBV) testing.
  2. Medical Schools will ensure that their courses do not contain any Exposure-prone procedure (EPP) exposure until there has been time to complete screening across each new cohort.
  3. It is expected that the majority of students will agree to undergo testing. In the event that a student chooses not to be tested s/he cannot be cleared to undertake EPPs and this may have implications for other vaccinations (e.g. BCG) and therefore placements.
  4. Normally, medical students will be screened for hepatitis B, hepatitis C, and HIV. Testing will be managed by Occupational Health Professionals who will supervise pre- and post-test discussions, the performance of the tests and the recording of outcomes, as per the testing of other health care workers.
  5. Medical Schools will make clear their requirements with respect to BBV screening on their websites, in their prospectuses and in information supplied to students and applicants.
  6. Medical Schools, in conjunction with their NHS partners, are responsible for arranging appropriate training for those ineligible to undertake EPPs.
  7. All aspects of a student’s medical record will be bound by the same duty of confidentiality as for any doctor/patient interaction and informed by the same ethical guidance. Students should be reassured that test results will not be disclosed.
  8. The testing protocol used by UK Medical Schools will conform to the standards set out by Association of National Health Occupational Physicians (ANHOPS) and the Association of NHS Occupational Health Nurses (ANHONS) and endorsed by the Department of Health: Tests performed abroad must be repeated in the UK and only the UK result will be accepted.
  9. [rather long; redacted]
  10. The cost of managing the BBV screening process should not be the responsibility of the student.

BMA guidance on the matter is also very clear:[6]

“It is GPC’s view that there is no obligation under the GMS regulations for a practice to provide occupational health services for patients. That responsibility rests with the employer under Health and Safety Legislation, and in occupations where there is a risk to health from any form of work related infection it is the employer’s duty to assess that risk and, if present, to protect the workforce. Examples of the groups that are considered at occupational health risk and require hepatitis B immunisation is set out in Chapter 18 of the Green Book (see extract in Appendix 2).

“The same applies for healthcare students who often request a hepatitis B immunisation prior to, or on entering, a course. Medical Schools are legally responsible for providing a full occupational health service to their students and applicants. This should include appropriate training for example in risk reduction and coping with needle stick injuries. By providing a hepatitis B immunisation, a GP could place inexperienced healthcare students at risk by providing a false sense of security and potentially exposing them to clinical risk of other blood borne infections, including HIV and hepatitis C, before they have received appropriate training.”

(The BMA wrote to the Medical Schools Council about this in 2012.[7])

Any arrangement which requires medical students to be immunised (and ideally they’d be tested first) prior to entry to medical school risks either the NHS being asked to pick up the tab – which it is not supposed to do, and means diverting resources away from patient care; or the student being asked to do so. In today’s “the consumer must pay” world, perhaps that’s where we will end up; with medical students being required to pay for their own screening and immunisation before they start university. Many will find this principle objectionable. Apart from anything else, it runs counter to the broadening participation agenda as it would tend to further institutionalise barriers to students from less wealthy backgrounds – students who are already disadvantaged in so many other ways (how much harder is it to get the relevant work experience if your parents don’t know any doctors, for example?).

It is not clear whether the Student Health Association has a position on this.

Medical school saints and sinners regarding occupational health screening of medical students

Despite the apparent clarity of the guidance there are, every year, reports of students being told to obtain hepatitis B vaccination before they start at medical school (if not actually before they even apply).

A quick google search - and I hope that other ganfyd editors will help to expand this - shows that, at least in April 2014, the following universities' policies can be classified into those that provide this occupational health service to their students after starting university (as the guidance says they should), and those that try to pass this cost on to either the student or the NHS:

Saints
Sinners
  • Birmingham medical school, according to this DNUK thread members only, should be on the "saints" list above; however according to the experience of parent who called one of the ganfyd editors when told their daughter was supposed to obtain BCG vaccination before starting there, and a colleague on an email list when an enquiry was made they received the following reply, it clearly belongs on the "sinners" list:
"The University of Birmingham does require vaccination prior to starting the medical course due to the students participation in clinical placements. We recommend prospective students speak to their GP, if their GP can not provide the services we recommend they enquire locally to private clinics, health centres or travel clinics.
"This is a requirement of the University, if the student is having difficulty fulfilling the non-academic requirements he should consult with the Admissions Department."
  • St George’s "Please contact your general practitioner (GP) to arrange screening for infectivity from Hepatitis B. You should begin a course of Hepatitis B immunisation as soon as you submit your UCAS application, as it consists of three injections over a six-month period." [8]
  • Durham "As a future medical student, you are advised for your own protection and that of your future patients to commence a schedule of Hepatitis B immunisation. The immunisation schedule that we recommend is a standard primary course of 3 injections over 6 months followed by a blood test to confirm immunity 2 months later. It is recommended that these vaccinations begin before you leave home for university as the course of Hepatitis B immunisation is lengthy, consists of several appointments and is required for a small number of optional placements in Year 1. Where a student believes that they are unlikely to be able to complete their primary course of Hepatitis B immunisation prior to starting the MBBS programme, they should contact the Director of Clinical Learning or Placement Coordinator once their offer of a place becomes unconditional in order to discuss alternative arrangements."[9]
  • Bristol "You will be required to have had two Hepatitis B immunisations prior to arrival at your own expense."[10] (Bristol does, at least, specify that it will have to be at the student’s expense rather than on the NHS – even though this flies in the face of the Medical Schools Council principles.)
Mixed reports
  • Liverpool University, according to this DNUK thread members only, does offer students hepatitis B vaccination; but if, for any reason, students are unable to attend on the appointed date, they are told to go to their own GP for the vaccine, presumably with the expectation that the NHS will then pick up the tab.

References

  1. Parker G, Jenkins S. Hepatitis B and admission to medical school: an audit of British medical school policy. BMJ 1996;313(7061):856-857.
  2. Medical Schools Council, Council of Heads and Deans of Dental Schools, Association of UK University Hospitals, Higher Education Occupational Physicians Group. Medical and dental students: Health clearance for Hepatitis B, Hepatitis C, Hiv and Tuberculosis. Guidance from the Medical Schools Council, the Council of Heads and Deans of Dental Schools, Association of UK University Hospitals and the Higher Education Occupational Physicians Group. London: The Medical Schools Council, 2008 (1 February).
  3. General Medical Council, Medical Schools Council. Medical students: professional values and fitness to practise. London: General Medical Council and Medical Schools Council, 2009 (November)
  4. Medical Schools Council. Guiding principles for the admission of medical students: London, 2010 (March); 1-2.
  5. Department of Health/Health Protection Division/General Health Protection. Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers. London: Department of Health, 2007.
  6. BMA General Practitioners Committee. Focus on hepatitis B immunisations: guidance for GPs. London: British Medical Association, 2012 (August)
  7. Laurence Buckman. Hepatitis B immunisations for medical students. Letter to Medical Schools Council. 2012 (1 August).
  8. St George's University of London. Entry requirements: Medicine MBBS (graduate entry) UCAS code: A101. Last update date not stated. Viewed 2014 (5 April).
  9. Durham University School of Medicine. Health Requirements for Admission. Last update date not stated. Viewed 2014 (5 April).
  10. University of Bristol Medical School. Frequently Asked Questions: Will I need to have any immunisations to join the programme? Last update date not stated. Viewed 2014 (5 April).
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