Host should also protect students on electives from HIVBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7384.338/a (Published 08 February 2003) Cite this as: BMJ 2003;326:338
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Tai, Neilson and Boffard proposed that hosts for medical students on
electives should develop protocols for handling sharps to help protect
students from exposure to HIV1. We feel that protecting medical students
from exposure to HIV and other blood borne diseases is not a problem just
for institutions hosting medical student electives but that it should be
tackled by all medical schools for all medical students. Any patient has
the potential to carry a blood borne disease and students should be taught
to take adequate precautions for all patients.
We recently conducted a small study observing year 4 medical students
inserting intravenous cannula on ward patients. The results for infection
control and handling of sharps are worrying (Table 1). Anecdotally some
students didn’t wear gloves as they felt the patient wasn’t in an “at risk
Table 1. Observations of medical students in infection control and sharps handling for insertion of intravenous cannulae. Yes No Take sharps bin to bedside* 18 (53%) 15 (44%) Decontaminate hands 8 (23%) 26 (77%) Wear gloves 24 (71%) 10 (29%) Dispose of sharp in sharps bin* 15 (44%) 18 (53%) * NB: in one case a supervising junior doctor took the sharps bin to the bedside and disposed of the sharps.
A study by Goodfellow and Claydon of recent medical graduates in
England showed that many were inexperienced in invasive practical
procedures2. How we teach and assess students in invasive practical
procedures needs to be addressed and strengthened. Guidelines/protocols
for practical procedures need to be developed that are transparent and
reflect best practice. These guidelines need to be disseminated to
students and their tutors. However, one of the main perceived problems is
that students are not observing good practice by doctors involved in
invasive procedures on the wards. Unless poor role modelling is addressed
guidelines and protocols will have little impact.
Dr SC Rennie, BST SHO, Ninewells Hospital, Dundee.
Mrs L Malek, SCOT project officer, University of Dundee.
Ms JR Rudland, Lecturer in Medical Education, University of Dundee,
1. Tai NRM, Nielson S, and Boffard K. Host should also protect
students on electives from HIV. BMJ 2003; 326: 338 - 338.
2. Goodfellow PB, Claydon P. Students sitting medical finals – ready
to be house officers? J Roy Soc Med 2001; 94: 516-520.
Competing interests: Table 1. Observations of medical students in infection control and sharps handling for insertion of intravenous cannulae.Yes No Take sharps bin to bedside* 18 (53%) 15 (44%)Decontaminate hands 8 (23%) 26 (77%)Wear gloves 24 (71%) 10 (29%)Dispose of sharp in sharps bin* 15 (44%) 18 (53%)* NB: in one case a supervising junior doctor took the sharps bin to the bedside and disposed of the sharps.
Tai and Nielson’s trauma unit should be commended for their efforts
to protect foreign students from HIV during their elective attachments.
They describe an induction package for students concerning needle-stick
injuries as well as 24 hour support from an HIV specialist nurse and
immediate availability of HIV post exposure prophylaxis. It is useful for
foreign students to know the support that will be available to them during
their elective attachment in the trauma unit at Johannesburg General
However, their argument that the above measures should be regarded as
a minimum for any institution hosting elective medical students is
unrealistic at present. This needs development over time.
Whilst it may be possible for larger institutions to have such
procedures and measures in place, smaller rural host hospitals may find it
difficult or impossible to comply with Tai and Nielson’s recommendations.
Many students undertake electives in rural communities and hospitals
where such comprehensive education packages and post-exposure support may
not be fully available. These communities may not have availability of
post-exposure prophylaxis for their own permanent staff, or anti-
retroviral therapy for patients in the local community. If the lack of
these measures were to deter medical students from completing their
elective attachments in such communities then extremely valuable
experiences will be lost.
Tilzey and Banatvala describe updated medical school policies
concerning HIV protection on electives. (2)
Medical schools sending students on elective attachments should
ensure that, prior to departure, students are fully informed about the
management of needle stick injuries and post exposure prophylaxis as well
as many other issues concerning electives in foreign countries, including
malaria and other tropical diseases, personal safety, high-risk surgical
procedures and responsibilities of students, who are not yet fully
qualified doctors, to recognise their limitations in a foreign
Planning for the elective attachment should be an integral part of
any medical school curriculum. Despatching medical schools have a
responsibility to ensure that students are as well prepared as possible
prior to their elective attachments. This must not be devolved to the host
institutions unless a clear education and support package exists for
students in their new environment.
(1) Tai NRM, Nielson S, Boffard K. Host should also protect students
on elective from HIV. BMJ 2003;326:338 (8 February)
(2) Tilzey AJ, Banatvala JE. Protection from HIV on electives:
questionnaire study of UK medical schools. BMJ 2003;325:1010-1 (2
Competing interests: No competing interests