Safety


Before students arrive at your clinical setting (hospital or ambulatory), they will take a mandatory online module on PPE and will have been provided a safety checklist to review (both shown below). On July 6, 2020, all students are required to be observed donning and doffing at their site or by their preceptor.


Suggested Checklist for Preceptors Receiving Students

Site readiness checklist – This document for download will help to prepare for the altered circumstances attending the return of year 3 students as follows:

  • Implementation of student protection in patient care and teaching environments.
  • Plans for telehealth / online learning to cover absence from or lack of access to in-person care
  • Changes to assessment and concerns about and plans for achieving competency despite shortened rotations

Key messages for Students regarding Safety and PPE

The UBC Continuing Professional Development team and Nick Steel, Health and Safety Advisor for the UBC Faculty of Medicine, have developed a module for all students to take prior to arriving at the clinic. This module will teach and support learners with the following:

  • Donning and doffing
  • Personal Protective Equipment (PPE)
  • Right to refuse unsafe work

Click to take the PPE module that all students have taken.


See below presentation that was delivered to returning Year 3 students and additional resources for support.


Guidelines for Student Participation

Please review the following table which outlines which patients’ students are and are not able to see with appropriate PPE. Due to the changing nature of our understanding of the COVID-19 virus, we have updated our guidelines.  We still recommend that students do not participate in the care of patients with known COVID-19.  We added that once the patient is outside of the period of communicability, students may participate.  In addition, previously we recommended that students not participate in the care of patients who are high pretest probability for COVID-19 and the result is pending.  We found that there is considerable heterogeneity about what constitutes “high pretest” and so we have left this decision up to the team which includes the student.

This guide is written from the perspective of student safety, is subject to change, and is not a clinical decision-making tool. Please check back for updates. Students are not to be involved in the Direct Care of patients with confirmed COVID-19 Infection

At the discretion of the attending physician and medical team, students are permitted to participate in all aspects of in-person care of patients in the groups identified by a green check mark provided that appropriate PPE is available. Students always have the right to refuse work they feel is unsafe without risk of academic penalty.
Any guidelines specific to a student’s hospital site or Health Authority still apply.

What patients can students see during their clinical experiences?

COVID-19 Test Result

Patient is Outside of the Period of Communicability*

COVID-19 Student Category

Not Applicable, Negative or Pending N/A
Positive No
Positive Yes

= students are permitted to see     = students are not permitted to see

* The typical period of communicability for COVID-19 is from 48 hours prior to the onset of symptoms through 10 days after the onset of symptoms.  This period may be longer in individuals with more severe disease or who are immunocompromised. The period of communicability is determined by the healthcare team using input from public health and guidelines from the BC CDC (outpatients; inpatients).

When can students participate in Aerosol-Generating Medical Procedures (AGMPs)?

Is COVID-19 Suspected in this Patient?

COVID-19 Test Results

COVID-19 Student Category

No N/A
Possibly (LOW →MODERATE pretest possibility) Negative
Possibly (LOW →MODERATE pretest possibility) Pending
Yes (HIGH pretest possibility) N/A
N/A Yes

= students are permitted to see     = students are not permitted to see

All patients should be screened for suitability before students are involved with in-person care. At the discretion of the attending physician and medical team, students are permitted to participate in in-person care of patients in the groups identified by a green check mark provided appropriate PPE is available.  Students always have the right to refuse work they feel, from their own perception, is unsafe. Any guidelines specific to a student’s hospital site or Health Authority still apply.
Participation must be under the guidance of the medical / surgical team

Risk Flow Chart

 

All patients should be screened for suitability before student are involved with AGMPs.
At the discretion of the attending physician and medical / surgical team, students are permitted to participate in AGMPs as long as appropriate PPE is available.
Students always have the right to refuse work that they feel is unsafe without rise of academic penalty.
Any guidelines specific to a student’s hospital site or Health Authority still apply.

* The COVID-19 Surgical Patient Assessment Form – Adult can be used to guide screening for risk factor and symptoms.  If the AGMP is neonatal resuscitation immediately after delivery, the mother should be screened.

** Corresponds to COVID-19 risk category GREEN on the BC CDC Protocol for Surgical Procedures During COVID-19

*** Corresponds to COVID-19 risk category YELLOW or RED on the BC CDC Protocol for Surgical Procedures During COVID-19


Caveats to the above guidelines

  • Students are allowed to participate in the intermediate risk (BC CDC green category) encounters provided that there is adequate PPE (surgical mask, eye protection, gown and gloves).In clinic if physical spacing is not possible, all participants in the educational process should wear masks and eye protection.
  • Students are considered workers by WorkSafeBC and thus have the right to refuse unsafe work.  Students should report any unsafe conditions to their preceptor for resolution.  Unresolved situations should be reported to Nick Steel, FoM Health & Safety Advisor at nick.steel@ubc.ca.
  • If students are exposed to a COVID-19 patient, they are to alert their preceptor and follow the HCW Exposure Risk Assessment Tool.  Students are eligible to receive expedited HCW testing if symptoms develop and should follow local facility procedures.
  • Students can participate in an autopsy if: the patient is COVID negative, PPE is worn, and the student is under the guidance of the pathology team.

Additional guidelines

The BC Centre for Disease Control and local Health Authorities may have additional guidelines to consider. Students are required to follow any enhanced PPE Guidelines at their local hospital or any enhanced PPE that is posted on patient’s door


Student Information

What to do if I get sick?

If you get sick while at home:

If you get sick during a clinical experience:

  • Don a surgical mask
  • Notify your supervising Preceptor
  • Go home (avoid using public transit if possible)
  • Use the BC COVID-19 Self-Assessment Tool to determine if testing for COVID-19 is indicated and arrange for testing if advised

For either of the above scenarios, if self-isolation is required, please follow the procedure to report an unanticipated absence at your site as posted in the Policy and Forms section of Entrada.

What do I do if I am exposed to COVID-19?

If exposure happens in either the clinical and/or non-clinical environment (e.g. someone in your household is diagnosed with COVID-19) you can use the BC Health Care Worker Exposures Risk Assessment Tool to assess the risk level (no risk, low risk or high risk) of the exposure and to obtain a recommendation of how to proceed based on whether you are asymptomatic or symptomatic.
Medical students are classified as non-essential Health Care workers (HCW).
HCW’s who develop symptoms after any level of exposure risk or environment type need to:

    1. EXCLUDE from work + SELF-ISOLATE as directed
    2. NOTIFY supervising Preceptor/delegate
    3. TEST – follow facility process to get tested or contact PWHCC

Students are encouraged to use the BC COVID-19 Self-Assessment Tool prior to entering the clinical environment each day as a means of routinely monitoring their health.
If self-isolation is required, please follow the procedure to report an unanticipated absence at your site as posted in the Policy and Forms section of Entrada.

When can I return to clinical experiences after being sick?

Reference the BC Health Care Worker Return to Work Decision Tree tool for guidance.

What should I do if I can’t find the appropriate PPE that is required for an encounter?

You should not participate in a clinical encounter if you do not have the appropriate PPE. Instead, notify your supervising Preceptor. If they are not available or if the issue is not resolved at the time, then move on to notify the Elective Owner or your home site Electives Director (listed below).

For any unresolved issues relating to access to PPE in a clinical encounter, please notify Nick Steel, FoM Health & Safety Advisor at nick.steel@ubc.ca.