Medical elective

Please complete as much of the institution immunisation form as possible, contact your GP if necessary and bring the form with you to your appointment. Allow plenty of time for this form to be completed, often extra tests are required so you may need to come to more than one appointment. 

TB Screening
Many hospitals will require tests to exclude TB infection.  Some will request a Mantoux test.  This will not be carried out by the Occupational Health Service as most of you have already had a BCG vaccination and therefore will have a positive result.  However, we will offer you a Quantiferon TB blood test and/or a Chest Xray (the OH nurse/advisor will follow the Host forms to determine what test is needed). If necessary will write a signed letter stating the date of your BCG vaccination, visible scar test and Quantiferon blood result. Please note the cost of TB tests are not covered by the medical school, you will need pay for this at your appointment (We only accept card payments).

Immunity Tests
Most hospitals in USA, Canada, Singapore, Australia & New Zealand require documentary evidence of tests for immunity against hepatitis B, rubella, measles, mumps and chicken pox.  You will need to have blood tests taken if you do not have serology results showing immunity.  No charge is made for serology tests for your main elective (unless it is a TB test). If you are doing a split elective you will be required to pay for the second elective tests.

MRSA
Some hospitals will require MRSA screening, often two weeks after your last contact with a patient and before you leave for your elective.  Swabs can be collected from the OH department.  Allow up to 2 weeks for the results.

Medical Examination
If a medical examination is required by a physician please discuss this with the nurse at your elective appointment and the appropriate appointment can be made.

Needle stick accidents can happen on electives.  We have a number reported each year.  If your elective is in a country where there is a high incidence of HIV (ie more than 1%), we recommend that you watch the HIV PEP talk which will provide cover information on HIV and HIV Post Exposure Prophylaxis (PEP) unless you have had confirmation that you can access PEP at your hospital within an hour of an exposure. This talk will also discuss what to do in the event of a BBV exposure and subsequent treatment with HIV PEP, so you are fully informed of treatment, side-effects etc.

Once you have watched this video, please complete this online form to request your HIV PEP 5-day Starter Pack from NOMAD Travel Clinic.

A member of the pharmacy will contact you to discuss your request. Please note each individual will need to submit the form as you will need to have a consultation with the Pharmacist prior to issue. The cost of the 5 day starter pack will be £250 and 3 day starter pack will be £150. Payment will be required by the Pharmacy in advance before your order is dispatched.

Please ensure you state which starter pack (3 or 5 days), write Imperial College and the date of departure.

A full copy of the HIV PEP information guide can be downloaded in PDF format.

Personal Protective Equipment

Hospitals and clinics, particularly in developing areas may not be able to provide you with the personal protective equipment (PPE) you take for granted in the UK.  If you think this may be the case, take supplies with you.

Consider taking gloves especially if you will be doing surgical specialities, trauma or obstetrics in a country with a high HIV prevalence. If you are in a country with a high incidence of TB, consider taking Respiratory Equipment with you - OH are unable to provide this at present.

The Occupational Health staff will advise you on appropriate health precautions for travel, using NaTHNaC, the main UK reference database.

Travel vaccines will be given for your main elective destination, the cost of other vaccines required for a second elective will not be covered by the medical school and you will need to pay.

Occupational Health will not cover vaccinations for travel destinations outside the country of your elective.  All extra travel plans will need to be discussed with your GP/travel clinic. 

You may require anti-malaria medication. If this is required, we can provide you with advice and a prescription. However, please note the cost of malaria medication is not covered by the medical school. 

College Travel Health insurance is available for elective students, full details of the policy can be found on the College Finance webpage. You will need to download the College policy number and take it with you on your elective.

Please take a look at our Travel webpage for information on travel health guidance, we have also included a number of useful websites which are a good source of information to help you plan your elective.

TB is a serious disease with prevalence being high in many of your chosen elective countries

A cumulative exposure of 8 hours or more with an infectious patient is generally accepted as an appreciable risk. This risk will increase for those students in high incident countries and if working in high exposure departments.

You have a responsibility to control the risk

1. High Risk Specialities: HIV clinics or wards / TB clinics or wards / A&E / Infectious Diseases
2. High Risk Patients: Those with HIV, TB
3. High Risk Procedures: Sputum Induction, Bronchoscopy, Intubation

• Assess the risk posed by the incidence of TB in the area:  High risk is usually defined as more than 40 cases per 100,000/year in a population.
• Consider speciality of elective work:  Considerations here relate to the nature of the placement (e.g. TB ward versus a community obstetric unit) and/or specific occurrences of significant exposure to someone with TB e.g. bronchoscopy etc.  Length of contact with an infectious individual is considered relevant with standard practice to regard 8 or more hours cumulative contact as significantly increasing risk of transmission of TB.
• Is Respiratory Protective Equipment provided? If not, consider taking masks with you - OH are unable to provide this

Managing risk during elective

• Comply with infection control policies such as wearing of masks, minimising contact time and/or exposure in high risk situations.

On Return from your Elective

You will be sent a letter from the FEO informing you of what to do if you experience any symptoms of TB. Report TB symptoms promptly to Occupational Health (OH) as soon as recognised:

• Persistent cough often with sputum, can be bloody
• Weight loss
• Lack of appetite
• High temperature of 38C or above
• Night sweats
• Extreme tiredness
• A sense of feeling unwell

Occupational Health (OH) is happy to advise if required. Please note that you do not need to have travelled abroad to be at risk of infection. When you begin your work in your first F1 post, you should inform your Trust’s OH Department if you have had exposure to TB infecton and if you have recently worked abroad. The Trust OH Service may wish to screen you for latent TB and treat you for this, if you tested positive, to guard against future risk to vulnerable patients if you later developed active tuberculosis. For this screening to be reliable, it should be carried out at least six weeks after the end of the period of potential exposure i.e. at least 6 weeks after you finished your elective (testing too early can produce a false negative result). This will be once you have started your F1 post.

Your duties:
Medical students have a duty

• To comply with control of infection policies of hosting organisations and good clinical practice,
• To comply with medical school health checks on return from elective
• To consider responsibility to self and patients in line with GMC guidance
• To recognise symptoms and if present seek appropriate medical advice

 All students should remain vigilant for symptoms of TB on return from elective