Visiting Students’ Elective Programme
Application Form
BARTS AND THE LONDON SCHOOL OF MEDICINE AND DENTISTRY
INTRODUCTION
Thank you for your interest in applying to Barts and the London School of Medicine
and Dentistry for an elective attachment.
Barts and the London is part of Queen
Mary, University of London, and offers international levels of excellence in research
and teaching in two main centres in Whitechapel in the East End of London, and at
Charterhouse Square in the City of London. The area is served by Barts and The
London NHS Trust, which is a major referral centre offering all of the major
specialties, serving a large area with a diverse and cosmopolitan population.
Barts and The London NHS Trust is a Centre of Excellence for Cardiology and
Cancer, based at St Bartholomew’s Hospital. It has the largest centre in the UK
offering 24 hour emergency care for people having heart attacks at its London
Chest Hospital site, and is a leading cancer treatment and research centre offering
a full range of treatment for cancer in partnership with Cancer Research UK (CRUK).
The Royal London Hospital in Whitechapel is a level one trauma centre
operating the Helicopter Medical Emergency Service from a helipad on top of the
hospital bringing major trauma patients from all over the south of England.
The Trust has a comprehensive portfolio of specialist services offering leading and
innovative care in anaesthesiology, allergy medicine, diabetes and metabolism,
dermatology, ENT, endocrinology, care of the elderly, gastroenterology, a
hepatopancreaticobiliary centre, infection and immunity, maxillofacial surgery,
neurosciences, ophthalmology, orthopaedics, plastic surgery, respiratory medicine,
sexual health, urology and women’s services and also has large dental and children’s
hospital offering a similar a wide range of related services.
In making your application to the school we encourage you to name several
specialities that you are interested in, so as to increase the chance that we can offer
you an elective placement. Placements in all specialities are limited and availability
can vary at different times. The School charges a non-returnable fee of £100 to
cover administration costs, payable at the time of application.
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As an elective student at our school you will gain an exceptionally wide range of
clinical experience and develop a good understanding of the healthcare needs of the
diverse community in our state-of-the-art facilities.
Our staff are experts in the
research areas of translational research, cancer, cardiac, dentistry, inflammation,
endocrinology, metabolism, immunology and infectious diseases, genomics,
neuroscience, gastroenterology, epidemiology and primary care.
Elective attachments may be arranged at the following hospitals:
THE ROYAL LONDON HOSPITAL WHITECHAPEL , LONDON E1
The hospital was founded in 1740, in Whitechapel, to serve the sick poor
amongst the merchant seaman and manufacturing classes of the east end of
London and in 1785 opened England’s first medical school, The London Hospital
Medical College. The main buildings of the new medical school remain adjacent
to the hospital. The Royal London will soon be Britain’s biggest new hospital as a
major rebuilding programme continues alongside the original buildings. All of the
major specialisms are based here, apart from cancer, cardiology and respiratory
medicine. Both the childrens’ and dental hospitals are based here.
ST BARTHOLOMEW 'S HOSPITAL WEST SMITHFIELD, LONDON EC1A
Founded in 1123 for the sick poor of Smithfield it served the City of London from
the mediaeval period through to the modern day as St Bartholomew’s Hospital.
As part of the Barts and The London NHS Trust it is being refurbished to provide
the Cardiac and Cancer Centres of Excellence.
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THE QUEEN ELIZABETH CHILDREN’S SERVICE AT THE ROYAL L ONDON HOSPITAL
A children’s hospital was started in the east end in 1866, and developed as
Queen Elizabeth Hospital for Children in Hackney. The services moved to the
Royal London in 1998 to a dedicated unit.
THE L ONDON CHEST HOSPITAL BONNER ROAD, LONDON E2
The hospital was founded in 1848 to offer treatment for consumption
(tuberculosis) to people of the East End. At that time tuberculosis accounted for
20% of all deaths and the disease remains a major concern amongst our
population. It is now a major specialist unit in the treatment of heart and lung
diseases and is the home to the innovative Heart Attack Centre, the largest of its
kind providing 24 hour emergency case for people having a heart attack, which
reduced the number of deaths in these patients by 50% within the first year of its
opening.
Electives may last between two and eight weeks, subject to availability. Students are only
permitted to take one elective period at the school during their medical training.
School of Medicine and Dentistry reserves the right to alter availability without notice.
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The
CRITERIA FOR APPLICATION
MEDICAL STUDENTS
You are eligible for an elective attachment at Barts and the London School of
Medicine and Dentistry if you:

are studying in one of the medical schools listed on the Avicenna/WHO database
and are in your final year of medical school at the time of your elective
attachment

are in good standing at your medical school and are able to provide a letter of
recommendation from your Dean of Clinical Studies

can meet the necessary occupational health requirements

If you are a national of a country outside the EEA or Switzerland you will need
a UKBA Tier 4 student visa in order for you to comply with the conditions of entry.
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APPLICATION FOR ELECTIVE ATTACHMENT FOR A VISITING MEDICAL OR DENTAL
STUDENT
T O BE COMPLETED BY THE VISITING STUDENT
1. Please attach a copy of your CV and a letter of recommendation from your Dean of
Studies
2. Personal details
Name of visiting student _____________________________________________ Sex
Date of Birth
Nationality_________________________________________________
Country of Birth____________________________Disability__________________________________
Address: __________________________________________________________________________
_________________________________________________________________________________
Home telephone number: _________
Email:
Name and address of home medical or dental school: _____________________________________
__________________________________________ ______________________________________
__________________________________________ ______________________________________
__________________________________________ ______________________________________
Name of Dean of Studies: _____________________ ______________________________________
Course (i.e. Medicine or Dentistry): _____________
Length of course: ____________________________ _____________
Expected Graduation Date (mm/yy) _____________
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Requested attachment
Period for which elective attachment is required:
Preferred subject / department:
From: __________________________________
To: ___________________________________
1st choice: _______________
2nd choice: _______________
3rd choice: _______________
Barts and The London School of Medicine and Dentistry cannot guarantee that we will be
able to place you in your preferred subject. We will endeavor to ensure that you are placed
somewhere if you choose subject which are highly competitive.
I confirm that the details given on the attached CV are correct. If accepted for this elective
attachment, I agree to abide by the Rules and Regulations of Queen Mary, University of
London, a copy of which will be given to me at enrolment.
Signed: _________________________________
Date: _________________________________
Print name: _____________________________
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GENERAL ADMINISTRATIVE INFORMATION
START DATE
Currently you can choose the weeks that best fit your schedule but these must be
agreed with your supervisor. In the future we plan to have most visiting students
coming to us in September so that we can offer an improved educational programme.
LENGTH
Electives should be between two and eight weeks and are limited to one continuous
elective period per student
FEES
£100 non-returnable administration costs of application
DEADLINE
You may apply up to a maximum of 18 months and a minimum of six months before
the proposed elective attachment.
You will be informed by e-mail whether your
application has been successful
PRIORITY
Priority is given to students from institutions that our own students visit on exchange
elective attachments
ACCOMMODATION
The School is unable to guarantee accommodation to visiting students. You would
be well advised to secure this once you have our offer. London has a wide range of
accommodation types but living costs can be expensive and, in addition to your
accommodation, you should consider the cost of food and transport.
ACADEMIC FACILITIES
You will be enrolled as an interim student member and will have access to services
such as computing and library facilities during your stay
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ON ARRIVAL
Students with a Tier 4 visa should take a copy of your passport and Tier 4 Visa to
Student Office, Room G08, Garrod Building, Turner Street, Whitechapel, London,
between 10.00-11.00 am on the first morning of their attachment to enrol with Barts
and The London School of Medicine and Dentistry. Please note that only original
documents can be accepted.
MALPRACTICE/LIABILITY INSURANCE
You will be covered for malpractice insurance by the School of Medicine and
Dentistry.
You will, however, need your own personal medical insurance.
PURPOSE OF YOUR ELECTIVE
The sole purpose for elective attachments within the Medical and Dental School is to
observe clinical work.
Students on elective attachment:

are not employed by the Medical and Dental School or Barts and the London
NHS Trust to provide services or to carry out work of any kind,

are not permitted to participate in or help with the investigation and treatment of
patients (including ordering of tests and taking specimens), to advise staff on the
treatment of patients, to teach clinical procedures, to carry out research or to
assist with laboratory work and/or other work,

are not normally permitted to visit intensive therapy units and may only visit areas
other than their base department with the express permission of their head of
department or supervising consultant,

are not entitled to remuneration or expenses from the Medical and Dental School
or from Barts and the Royal London NHS Trust
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APPLICATION PROCEDURE
1. You should complete the elective application form and submit it electronically with
your payment, CV and letter of recommendation to: [e.mclean-inglis]
Posted applications will not be considered.
2. Your details will then be circulated to the relevant consultants.
3. If a consultant of the School agrees to accept you an official email will be sent
within six weeks confirming the elective placement.
You must confirm your
acceptance of the placement within four weeks of our offer.
4. The acceptance letter will also include an occupational health questionnaire
which will need to be completed and returned to us one month prior to the start of
your elective
5. Additionally the School will require you to provide us with an up to date
police/criminal record check on your arrival. This is essential, you will not be
allowed to commence your elective without it.
6. The School of Medicine and Dentistry will require you to provide in advance,
proof of your immunity to TB, Rubella and Hepatitis B. If the elective attachment
involves participation in invasive surgical procedures only a blood result from a
UK laboratory will be accepted.
7. If you are a national of a country outside the EEA or Switzerland you will need
a UKBA Tier 4 student visa in order for you to comply with the conditions of
entry.
8. The School reserves the right to withdraw its offer to you depending on medical
advice.
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TIER 4: VISITING STUDENTS
Students registered full-time at an overseas institution can undertake a period of
short-term study in the UK, where that study is part of their qualification, provided that
qualification is at the same level or above as a UK degree. The UKBA stipulates the
student must not be in the UK for any more than 50% of the total length of their
course.
To apply for a visa, the student must receive a Confirmation of Acceptance for
Studies (CAS).
OBTAINING YOUR CAS AND YOUR VISA
If you do require a visa you must pass a points-based assessment and score 40
points to study. If you do not score 40 points you will not be eligible to study.
You must score

30 points for having a Confirmation of Acceptance for Studies (CAS) from an
approved education provider; and

10 points if you can show (and have documents to prove) you have enough
money for your course fees and monthly living expenses (known as
maintenance).
The Electives Assistant is responsible for preparing the CAS for Tier 4 applications.
You will be required to submit certain information and a copy of your passport photo
page.
SPONSORSHIP DUTIES
Once you have successfully applied for your new visa using the CAS, full
sponsorship duties will apply.
INFORMATION CHANGES
Immigration guidelines are subject to change at any time so check the UKBA website
regularly.
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VISITOR OR 'T OURIST' VISA
Students from outside the EEA or Switzerland must not enter the UK as a General
Visitor or tourist when intending to undertake an elective placement at Barts and The
London School of Medicine and Dentistry whether for research purposes, to attend a
short course or accompanying an academic. The General Visitor/tourist route is not a
permissible route of entry. The UKBA website clearly states that you cannot study
as a general visitor.
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PLEASE COMPLETE IN FULL AND EMAIL TO OCCHEALTH@QMUL.AC.UK
Barts and the London School of Medicine and Dentistry
Queen Mary University of London
Occupational Health Service
Elective Medical or Dental Student Health Questionnaire
Personal Details
Confidential
(Please complete in block capitals)
Family Name:
Date of Birth:
Given Name(s)
Title: (Mr / Ms etc)
Email address:
Mobile no:
Date elective due to start:
Date elective finishes:
Do NOT complete this form more than six months prior to
the planned commencement of your elective.
Consultant responsible for elective:
Specialty:
Your answers to this questionnaire will help us to ensure that your elective placement will not place
your health at risk and also to ensure that you are not suffering from a condition which could make it
impossible for you to work safely and effectively with patients during your elective. The information
provided is treated in strict confidence
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Please answer YES or NO to ALL the following questions and give details where necessary:
Are you currently being treated for, or
have a history of the following?
YES
NO
1. Skin problems or allergies including
latex allergy i.e. eczema, asthma or
dermatitis or an adverse reaction to any
medicine or substance
2. Have you or a close relative been
diagnosed or treated for tuberculosis?
3.
In the last 12 months have you
experienced:
a. a persistent, unexplained cough
lasting more than 3 weeks?
b. Unexplained fever?
c. Night sweats?
d. Unexplained weight loss?
e. Coughing up blood?
4. In which country do you currently
reside?
5. Mental health problems including
phobias, stress, anxiety, depression, eating
disorders or drug / alcohol dependency?
6.
Are you taking any medication
(excluding contraception)?
7. Do you have a disability that may
require additional help or support for this
elective placement
8. Have you had any serious illness /
accident / surgical operation which you
have not previously mentioned?
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Details including dates (continue on
a separate sheet if necessary)
Dental Exchange / Erasmus Students ONLY
Exposure Prone Procedures
All dental Exchange & Erasmus students are required by the Department of Health in the UK to
provide evidence that they are not infected with hepatitis B, hepatitis C and human
immunodeficiency virus (HIV) before they can perform *EPPs.
*Exposure prone procedures are those invasive procedures where there is a risk that injury to the
worker may result in the exposure of the patient’s open tissues to the blood of the worker.
To avoid a wasted application, you must attach the following blood test results, written in English and
taken within the last six months to this questionnaire:
Hepatitis B surface antigen
Hepatitis C antibodies
HIV antibodies
Please note that these blood tests will be repeated in the UK, to confirm the results, before you are
able to do EPPs.
An appointment will be made for you to have the blood test in the Occupational Health Service at
Queen Mary, University of London on your arrival in the UK.
Declaration:
The information provided is correct to the best of my knowledge. I consent to a clinical assessment if
required.
Signed: ………………………………………………………Date: ………………………………………..
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Please take page 3 of this form to your normal occupational health care provider (doctor) or school
health professional to complete. Failure to do so will cause delay and may prevent you from
attending this elective.
Once all sections are completed fully, you should post the form and any supporting documentation
to:
Occupational Health Service, QMUL, Geography Building, Mile End Road, London E1 4NS.
If you have any queries, please contact the Occupational Health Service on:
+44 207 882 8700 or email: occhealth@qmul.ac.uk
For Occupational Health Service Use Only
Fit for elective:
Yes □
No □
Referred to: …………………………
Full Name: …………………………………………………… Signature:……………………………
OH Physician / OH Adviser: …………………………
Date: ……………………………….
Comments:……………………………………………………………………………………………………
………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………….
Barts and the London School of Medicine and Dentistry
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TO BE COMPLETED BY THE STUDENT’S NORMAL OCCUPATIONAL HEALTH CARE PROVIDER (DOCTOR)
OR SCHOOL HEALTH PROFESSIONAL.
So that the student can be health cleared for this elective, please supply the following vaccination and
blood test information, written in English. Failure to do so will cause delay and may prevent the
student from attending this elective.
Personal Details of the Student
Confidential
(Please complete in block capitals)
Family Name:
Date of Birth:
Given Name(s)
Title: (Mr / Ms etc)
Date
HEPATITIS B
1st
Hepatitis B vaccination
2nd
3rd
Booster
Hepatitis B Antibody blood test
MEASLES
Positive measles antibody blood
test;
OR two MMR vaccinations
1st
2nd
RUBELLA (German Measles)
Positive Rubella antibody blood test
VARICELLA (Chickenpox)
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Result
Does the student have a history of
having had chickenpox infection?
Yes / No
(please circle)
If NO, provide a positive varicella
(chickenpox) antibody blood test;
OR
details of two
vaccinations
varicella
1st
2nd
TUBERCULOSIS (TB)
Satisfactory Mantoux test result;
OR Chest X-ray result;
taken within the last 6 months.
Has the student received a BCG (TB
Vaccination)?
Yes / No
(please circle)
BCG Scar seen?
Yes / No
(please circle)
Name of doctor:
Date:
Signature:
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Official stamp of health care
facility: