Cate Breheny, a first year medical student, writes her take on the events that occurred during the controversial ‘compulsory redeployment’ of ICSM medical students in January of this year.
Whilst the dispute between students and Faculty over compulsory redeployment has now been resolved, questions remain over how Faculty, our Hospital Trusts, and ICSMSU will move forward. It seems that student-faculty and faculty-trust communication can be improved, as well as uncertainties over academic protections for students.
Over a two-week period this January, clinical years students were asked to cover nursing and healthcare assistant (HCA) shifts as a compulsory and unpaid alternative to their clinical placements. This decision sparked anger among students and was ultimately reversed with an announcement on 19th January, bringing Imperial’s policy in line with all other UK medical schools.
Third and Fifth year students began their 2021 clinical placements on the week beginning 4th of January in an atmosphere of uncertainty as the COVID situation escalated. At this point in time, the Faculty position was that students could be asked to take on extra responsibilities, such as taking bloods during their normal placements. This was poorly conveyed to students, with webinars scheduled during placement hours and beset with IT failures. Rapid changes in approach over the following days then left students confused, with some placements seemingly cancelled. Some were asked by Imperial College Healthcare Trust (ICHT, which does not cover all of Imperial’s teaching hospitals) to cover unpaid long shifts.
By the following Thursday, the situation changed dramatically following Faculty confirmation at another fifth year student briefing that students at ICHT would be compulsorily redeployed for 36 hours each week to cover nursing and HCA shifts without pay, including 12.5 hour “long shifts”. Faculty were anxious to ensure students were able to graduate and without time in a hospital setting, students may not have met the GMC Outcomes for Graduates. Some students had already been asked to do this work since beginning placements, however, and were increasingly worried about the effects on both their mental health and their learning. Although they would do crucial work, it was not linked to their medical school learning outcomes, and they were worried about the impact on their assessment performance. Imperial also went against advice from the GMC and MSC, who stressed that medical students’ first responsibility was to their education and all redeployment should be voluntary, paid, and not more than 12 hours per week.
Final year students received their rotas for their next six weeks of clinical placements the next day. Students assigned to ICHT were redeployed and informed that they should not leave shifts to attend teaching, while at other Trusts, placements continued as normal. ICHT, like many Trusts, had been under extreme stress due to COVID and desperate for staff. Students were concerned at the educational disparity with crucial final exams only eight weeks away: redeployed students were asked to clean rooms and make tea and coffee. Others were sent to ITU to cover grueling shifts, deepening concerns over their ability to sit exams after the forecast 6 weeks of redeployment. One student explained that “my health (physical and mental) has literally been damaged by being forced to work”, while the ICSMSU president, Muntaha Naeem, recalled students on the phone to him in tears.
The situation escalated over the weekend with students phoning Faculty and threatening to contact Defense Unions and the BMA. Their concerns centered around the loss of valuable medical learning time, weeks before their final exams, and the disparity between Trusts, so many found the Faculty’s insistence that redeployment constituted a learning opportunity galling. It is unclear whether staff had been briefed on what to say to students, with faculty-student communications seeming strained, and it was difficult to action any changes over that weekend. The lack of clear communication and pay would also have disproportionately impacted students relying on part-time jobs or who had caring and childcare responsibilities.
While ICSMSU were informed by Faculty that students were not obliged to work extra hours beyond 9am-5pm and should be paid if they did, it wasn’t possible to cascade this out to all students. This was also being directly contradicted by ICHT. There was no advice for students on how to log their hours and many students felt uncomfortable leaving if it would impact patient care. While this may be expected in the chaos of COVID, it nevertheless put students in a difficult position.
On the following Monday, ICSMSU released an open letter to Faculty detailing their concerns around compulsory redeployment, hoping to reassure incensed students that their voices were being heard. While the letter caused some controversy, over two-thirds of the students we surveyed agreed with its general message of concern over loss of learning. It is understood that the letter was helpful to Faculty in ensuring that Trusts understood student concerns.
ICSMSU raised concerns to Faculty in one of the many COVID ‘COBRA’ meetings at the same time. Faculty, deluged in student emails and calls over the weekend, recognised that compulsory redeployment was an issue. This fortunately coincided with the fortnightly COVID placement review. Following discussions with ICHT, a blanket ban on compulsory redeployment was formally announced by Trusts on Wednesday 20th and normal placements were reinstated. By this point, some third and fifth year students had effectively been redeployed for two weeks.
Concerns remain over the loopholes used by ICHT to redeploy students. This did not affect any other UK Medical School, so it is crucial to find out what specifically went wrong here. Hospital Trusts should not directly contradict the medical schools they are working with, prevent students from attending university teaching, or cancel their placement teaching. It is worse for everyone, including the NHS, if medical students fail unnecessarily. The Faculty must be able to communicate this to Trusts and present a united front. This would help prevent confusion among students and ensure they are fully supported in their roles by Faculty and Trusts in the event of a fourth wave.
Questions also remain around the lack of academic protections for students. Whilst Professor Amir Sam stressed that the teaching offered by the Faculty was impressive, especially in these uncertain times, it only seems fair to guarantee students a protected second chance. Students would have been happy to support the NHS and be redeployed if they did not have to worry about failing crucial exams. In future, if students are needed, postponing exams or introducing a no-detriment policy would free them to help.