Medical Students

Studying medicine

Pre-course information

If you have been offered a provisional place to study Medicine at Imperial College London you will be required to:

  • Complete a confidential health assessment questionnaire according to current national guidelines. This form needs to be returned to the Occupational Health Service by the given deadline date on the form. It is essential that you provide a full history of all your past and current health issues for a full assessment to be carried out determining your fitness for the course. 

    The vast majority of students are fit for the course and the medical school is informed. Any support and adjustments are offered as necessary and you may be asked to attend an assessment at the University if more detail regarding your health is required. Confidential specialist advice may be sought, and if there are concerns, a case conference may be held to ensure that all reasonable steps and support have been considered.

  • Complete an Immunisation Record Form. Please ensure that your vaccination history is recorded with dates of administration. You will need to acquire your vaccination history from your General Practitioner if you do not have the information required.

  • Please note that the immunisation form requires a signature and stamp from your General Practitioner, so allow time in advance to ensure that this form is returned before the deadline. It is your responsibility to ensure that this reaches us by the deadline. We strongly recommend that you ensure the correct postage is applied to the envelope.

tab - vaccination history

Hepatitis B

We advise that all prospective medical students have a least two doses prior to commencement of course. You will have a busy timetable once you start and it can be difficult to attend appointments for further vaccination. There is also the opportunity to learn phlebotomy skills during the first term and if you are not vaccinated, this may result in you not being able to participate. If you are unable to obtain or complete this immunisation prior to entry, this will be done by the Occupational Health Service on commencement of the course.

The preferred course for full protection is 3 vaccinations of Hepatitis B vaccine over a period of six months, with a final blood test after the third dose to check that the vaccination has been successful.

On entry, full Hepatitis B immunisation history will be confirmed and a blood test taken for Hepatitis B surface antigen and Hepatitis B antibodies.

Note: We are aware that there is currently a shortage of Hepatitis B vaccine and you may find it difficult to obtain.  Please do not worry, Occupational Health will vaccinate you when supplies resume.

Measles, Mumps & Rubella

All students should have a documented history of two doses of MMR vaccine, which is usually given in early childhood to prevent the spread of infectious diseases or provide serological evidence of immunity to measles, mumps and rubella from an authenticated laboratory. If you are unsure of your vaccination history, please consult your General Practitioner (GP) who should be able to provide you with a booster MMR vaccination if necessary.

Tuberculosis

BCG vaccination is recommended for all medical students where there is a risk that they may come into contact with patients infected with TB.

All students need to provide documented proof of BCG vaccination or evidence of a visible BCG scar.  If you have not had this vaccination in childhood you may be able to obtain this from your GP.  If you are not able to source this yourself, you will be seen by the Occupational Health Service on commencement and this vaccination will be given, unless medically contraindicated.

All new entrants to the NHS who have been living or working overseas  for more than 3 months in a country where there is a high prevalence of TB may be required to have additional screening tests.

Varicella

If you cannot confirm history of this disease, you will be required to have blood test and will be offered vaccination if necessary.  Students who have had the disease diagnosed in a tropical country will also require a blood test to ensure immunity.

Dip/Tet/Pol

All students should have a documented history of five doses of DTP vaccine. This is part of the childhood immunisation programme to prevent the spread of infectious diseases.

Clinical work

Infection Control

Clinical work exposes you to the risk of infection and injury.  Infection with HIV or blood-borne viruses can restrict you from working in some areas of surgery, patients are also at risk.  Careless hygiene practice by nurses and doctors are a major cause of wound infection and contribute to thousands of patient deaths each year. 

How to avoid the risk to yourself and your patientsHow to protect yourself
 Getting vaccined and staying vaccinated Clinical vaccinations for Hepatitis B, tuberculosis, Measles, Mumps, Rubella and Varicella are a requirement on entry
 Learn and always follow safe sharps practice Before going on any ward, cover unbroken skin
 Always follow infection control procedures Always wear gloves if you are dealing with sharps, have active eczema on hands or when doing any internal or external examinations or dressing of wounds
 Report and seek help with any needle stick accident  
Summary of the table's contents


Safe Sharps Practice

Inoculation accidents, “needle sticks”,  hypodermic needles and scalpels are your biggest risk of dangerous infections.  Carry out safe practice when using and disposing of sharp instruments. 

DoDon't
 Wear gloves Re-sheath a needle
 Take sharps bin with you Carry used sharps in your hand
 Wear eye protection if appropriate Try to retrieve anything from the sharps bin
 Cover all cuts and abrasions with a waterproof dressing Bleed known high risk patients
 Use vacutainers rather then needle and syringe  
 Discard immediately into sharps bin  
Summary of the table's contents
It takes time to become proficient at taking blood. Learn from good teachers. Don’t be afraid to ask an experienced Phlebotomist, Nurse or a Doctor to supervise you if you are finding it difficult.

Leigh Turvey

Senior Occupational Health Nurse


Protect your patient

A hospital acquired infection or nosocomial infection contracted during medical treatment is a huge problem in hospitals and causes thousands of patients to die each year. The most important control is also the simplest and the cheapest - handwashing!. This prevents accidental transmission of infection from patient to patient via the hands of their carer: medical students included!

All hospitals have defined procedures to try to prevent the spread of infection.  These must be followed.  Don’t cut corners, don’t follow bad or careless practice.  Our first duty is always to the patient.
 

Always wash your hands

BeforeAfter
 Contact with wounds and IV sites  Removing gloves
 Taking blood  Contact with a patient suffering from an infection
 Contact with susceptible patients  Changing or 'lifting' dressings
 Carrying out any internal examinations  Going to the toilet
 Eating  Assisting a patient with toileting
Summary of the table's contents

Barrier Nursing

Patients with contagious disease or infected with dangerous bacteria such as MRSA (Methicillin Resistant Staph. Aureus) or those who may be especially vulnerable to infection (immune-deficient) will be barrier nursed. 

Successful barrier nursing is entirely dependent on all persons in contact with the patient following procedures.

If you are seeing a patient who is being barrier nursed, always:

  • Wear protective equipment provided
  • Report missing equipment to the nurse in charge
  • Remove gowns, gloves and masks before leaving the room
  • Close the door after entering and leaving
  • Wash hands immediately after examining the patient and before leaving the room, even if you have worn gloves

Personal Illness

If you are unwell with an infectious illness, you may transmit this to a patient if you are on the wards or in clinics.  Patients are vulnerable.  An infection that is a minor for you can be lethal to the very old, very young or very sick patient.

You must stay off the wards or clinic if:

  • You develop any possible infectious rash
  • You are unwell with diarrhoea or vomiting
  • You have been in contact with chickenpox or shingles (unless you have proven previous infection)
  • You are unwell with a feverish illness

Report contact with chickenpox to the College or Hospital Occupational Health Service.

If you think you may have contracted HIV or other blood-borne infection, you have a duty under the GMC regulations to report this in confidence to the Medical School or the College OH physician.

Blood-borne Infections

Blood-borne viruses are carried in human blood, tissue and secretions.  Accidental exposure can result in you becoming infected and in some individuals cause severe disease.  Although occupational transmission of these viruses is rare, all unscreened blood samples should be treated as potentially infectious. Infection is not only damaging for your health—it could destroy your career.

The three main blood-borne viruses in the UK are:

  • Hepatitis B
  • Hepatitis C
  • Human Immuno-deficiency Virus (HIV)

Blood-borne virus risk may arise from: human blood, amniotic fluid, cerebrospinal fluid, breast milk, pericardial, peritoneal  and pleural fluids, saliva, synovial fluid, semen, vaginal secretions, unfixed human tissue, exudate from burns or skin lesions and any visibly blood-stained fluid.  And of course blood borne viruses can be introduced via any break in the skin or via a splash to mucosa eg eyes and mouth.

Avoiding the risks


Vaccination

  • Hepatitis B can be effectively avoided by vaccination, ensure that you complete the vaccination programme.

Follow safe sharps practice

  • The most common exposure risk comes from careless handling of hypodermic needles and IV cannulas, cover broken skin on hands with a waterproof dressing. Wear gloves when dealing with blood or body fluids, they do not always stop a penetrating injury, but they do reduce the volume of blood inoculated.
  • Never re-sheath needles.
  • Dispose of used sharps into a proper sharps bin immediately after use.
  • Do not carry used sharps in your hand.  Use a kidney dish or take the sharps bin to the bedside.
  • Ensure that you are supervised when carrying out new procedures until you are competent and confident.

Reporting an incident

  • If you ever injure yourself with a needle or other contaminated sharp during clinical training or get a blood splash on to broken skin or into your eye nose or mouth get help from the hospital Occupational Health department or outside core hours from A&E.
  • You should report any exposures via the College online accident reporting system.
  • You also need to report it to the Trust and inform the School and to the College Occupational Health department.

Clinical students must not carry out venesection/invasive procedures on patients known to be Hepatitis B, HIV or Hepatitis C positive until all DOPS are signed off and Year 3 exams including the OCSE are passed.

Summer Placements

Undergraduate medical students arranging summer placements which do not form part of their formal course may be required to complete a health screening questionnaire from the institution prior to acceptance.  This will usually include details of their vaccination history. However, students may also be asked to supply details of tests which are not usually required for studying medicine in the United Kingdom.  

The College Occupational Health Service may be able to assist students in preparing for such placements but please note that students will be responsible for the fees for blood tests and/or a chest x-ray.

Students who are arranging summer placements in destinations where travel vaccines are recommended, will need to make arrangements to have these through their GP or a commercial travel clinic such as MASTA or Nomad.

Students travelling to countries with a high risk of HIV are strongly advised to take HIV prophylaxis with them.  This can be obtained from Interhealth Worldwide.

Students are not covered by the College travel insurance scheme and will need to get their own insurance.

All information from the institution requesting tests must be brought to the appointment in paper format – not on your phone or laptop!