Clinical placements for medical students in England need to be “fundamentally rethought” because staff shortages and funding constraints are putting the current model under “significant strain”, a new report has argued.

“Shortages in supervision, limited capacity and uneven quality [are] threatening both student learning and patient safety,” the paper published by the ����Vlog Policy Institute (Hepi) and the University of East London says, adding that “incremental change” will not address such challenges.

All medical and nursing students must currently complete clinical placements as part of their degree, but the report notes that they are governed by a wide array of professional, statutory and regulatory bodies, creating a “fragmented and complex ecosystem”.

There were more than 106,000 vacancies across secondary care in the NHS as of December 2024, the report outlines, putting traditional placements under threat because clinicians don’t have the capacity to support students alongside their day jobs.

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It warns: “Burnout, limited placement opportunities and disjointed education-to-employment pipelines create additional challenges for healthcare students and risks deterring new entrants at a time when the country needs them most.”

Amanda Broderick, the report’s co-author and vice-chancellor of the University of East London, said “incremental adjustments will not be enough”. 

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“We need bold, innovative approaches that harness the full potential of simulation, technology and new models of supervision, while deepening partnerships between universities, NHS providers and community organisations. 

“Our goal is to shift the conversation from ‘more placements’ to ‘better placements’: placements that are equitable, flexible, future-facing, and designed around both workforce needs and student success.”

The paper says that universities and the NHS need to “challenge legacy assumptions”, and recommends that placements involve a greater use of simulation and digital learning as well as new supervision frameworks that ease pressure on clinical staff, and community-based models that widen access to “diverse learning environments”. 

Examples of “simulated placements” include using mannequins, actors and virtual platforms to replicate real-world scenarios.

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University of East London students already complete 150 hours of such virtual simulation as a preparatory pre-placement experience. After this was introduced, there was a 40 per cent increase in students reporting improved confidence.

Meanwhile, the University of Sunderland in London has developed a “participatory” student placement at HMP Pentonville, a “non-traditional” healthcare setting where the students can receive one-to-one supervision.

“Incremental change will not address the challenges to creating high-quality placement opportunities across the health and care sector,” the report says. “Now is the moment to fundamentally rethink and redesign clinical placements collaboratively...a strategic, regionally coordinated approach to placement design, supervision, organisation and evaluation can unlock significant growth in student capacity across the health ecosystem.”

Broderick added that by “challenging old assumptions and reimagining what placements can be, we can help build the confident, agile and compassionate workforce the NHS requires to meet the challenges of the next decade and beyond”.

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Hepi director Nick Hillman said: “The NHS can only cope with the ageing population if it has a workforce to match”.

“This report reveals how to resolve the difficult blockages in the training pipeline to unlock capacity and improve quality. I hope ministers respond constructively.’

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juliette.rowsell@timeshighereducation.com