Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Shadowing Me

Some people have asked what may be expected of a pre-med student who is shadowing a physician. I thought that I would write a bit about what I provide and expect on this shadowing experience. The expectations of the physician and the experience of the shadower definitely vary but I hope that this description provides those who have not shadowed with some things that might make the experience better.

Legal Matters

I have a confidentiality sheet that all pre-medical and medical students must sign before shadowing me. It outlines the confidentiality rules such as you may not disclose the name, condition or any other identifying information of any of the patients that you encounter during the shadowing experience. It also outlines that your may not write on any patient document while in the hospital and it outlines that you will observe all rules and regulations as you are directed by the staff of the hospital. These rules are for protection of the privacy of my patients and are pretty clearly outlined before you come to the hospital.

Dress

I ask that shadowers dress in business attire for the experience. This includes suits for males and suit or dress and jacket for females. I don’t ask for white coat because I seldom wear one. I have a badge that identifies you as a Student Observer that you will wear on your jacket along with a name tag.  My patients expect that you will be professionally dressed and they are made aware of your presence. If I am going to be doing any procedures that you will be observing, I obtain their permission before you are allowed to observe anything. The staff is quite aware that I have shadowers from time to time and are very helpful in terms of making you feel comfortable. They understand the process and are happy to help me make sure that you have a good experience.

What I expect you to do

I expect you to have some expectations of what you want to achieve in participating in this experience. You should write down a few objectives and have these ready for me to go over with you. Are you there to learn about my specialty? Are you there to learn about the practice of medicine in 2008? Are you there to discuss your chances of admission into medical school? Are you there because you need an additional letter of recommendation for medical school? In short, jot down a few objectives for your visit and have them handy.

I expect you to bring a copy of your Curriculum Vitae (resume). If you have a photo attached, so much the better but I take a digital photo of you and place it with my copy of the signed Confidentiality sheet. If I am writing a letter of recommendation, I like to look at the photo and make sure that I remember the person correctly. Sometimes people will ask for a letter several weeks after their shadowing experience and I like to make sure that I remember the person.

I also like for you to bring a copy of your Personal Statement (PS) and the medical schools that interest you. I usually read your PS before we begin the day and I often offer tips for making the document stronger. I also can provide some information about specific schools that might be helpful to you. I can also suggest particular schools that might be a good fit for you too. Again, I add your PS and schools list to the folder that contains the documents that I have mentioned above.

The Day

I usually have people shadow on a day that I am in the hospital ,clinic and teaching. While it’s a long day, it usually gives the shadower a good experience. I usually have folks come on the day when I am not on call and have a lighter procedure day. I want to you see some cases but I also want you to have plenty of time to ask questions and understand as much about my practice as possible. I also will send you a list of the cases that I have scheduled and a brief description should you want to do some research before you observe.

Over lunch, which I provide, we usually discuss your career plans and I answer any questions that you might have. Again, I usually have taken a look at your CV, PS and schools list. If you are yet to take the Medical College Admissions Test (MCAT), I usually offer some tips about preparation for this very important exam. Since you will likely sit in on one of may classes, I usually give you a copy of my lecture notes so that you can follow along. The class is a great time for you to meet some of my pre-clinical medical students or some of the third-years that are on my service. They usually have loads of hints and suggestions about application to medical school.

When the day is done, usually about 5 pm (just before evening rounds), I usually go over any questions that you might have and any expectations that you have of me that we haven’t gone over during lunch. If you need a letter of recommendation, I ask that you provide a deadline for me so that I can make sure that you letter is out in a timely fashion.

Most shadowers get a chance to participate in morning rounds, a few cases, in my clinic and sit in on a class or lecture. I think that while the day is pretty full for you, it gives you a fairly realistic idea of what this profession involves. After all, this is your shadowing experience and you have a short period of time to make the most of your experience. I also feel that you need to have exposure to the daily routine of what I do so that you can compare your shadowing experience with me to others that you might have. Again, this gives you a more realistic experience.

Finally, I do have people who come back for a second day sometimes. These folks usually have shadowed me early in their undergraduate career and now want to spend a little more time working on buffing their application before they submit it. I certainly do not ever have a problem with this. I definitely recommend that people shadow at several stages in their undergraduate career as sometimes the shadowing experience can hone your desire to pursue medicine if you were unsure the first time around.

Good sources of names of physicians who will allow you to shadow are the local medical societies in your locale. Most local medical societies will have lists of physicians who will work with you. I know that in many large metropolitan areas the city medical society will make all of the arrangements for you. This was how I was able to shadow several physicians before I entered medical school.

Another source of physicians who will allow you to shadow would be any medical schools that are nearby. You might contact the individual clinical departments of the medical schools which may be able to match you with the name of a physician or two that would allow you to shadow. Other resources are your family or personal physician who may provide this service or know a colleague or two that might allow you to shadow.

The important things to do are:

  • Have a list of objectives that you want to accomplish on this visit.
  • Find out what the dress code will be, what time you are expected to finish and what the daily agenda will be.
  • Have a copy of your CV, personal statement and list of schools if possible (attach a small passport-sized photo) to your CV.
  • If you need a Letter of Recommendation, be sure to provide a deadline, an address as to where the letter should be sent and if the letter is going to an individual or a committee.

The last thing is to enjoy your experience being mindful of the person who is allowing you to shadow them. This means being mindful of the confidentiality of their patients and send a letter of thanks when you are done.

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6 January, 2008 - Posted by | application, medical school admission, physician shadowing

6 Comments »

  1. There are classes in ethics (and patient’s privacy rights) in medical school. Most of these types of topics are covered and discussed in POM (Practice of Medicine) courses. Learning how to navigate and disagree or question others in a professional manner is not taught (and can’t be)in medical school as one quickly realizes that medical school only provides the foundation from which one can go on to complete residency. Professionalism begins in the home with parents just teaching their children simple manners.

    Comment by drnjbmd | 10 January, 2008 | Reply

  2. >>>>A comment like “We are not violating the patient’s rights are we? ”

    That’s a great way to make people aware that their actions are being observed. It’s non-confrontational and even kind of innocent. But the nuance won’t be lost on anyone committing misdeads. I’ll remember it.
    Maybe there should be classes in diplomacy and ethics in medical school. Cheers!

    Comment by Emily | 8 January, 2008 | Reply

  3. To Emily,
    I have no problem speaking up. In one instance, I have said, “Be sure to check the permit or be careful of you photo angle”. I am very, very proactive about the patient’s privacy rights and I am also very careful to remove any identifying material from the examples that I use in lectures.

    Patients can only be photographed for educational purposes and not for “fun”. That was the problem with the actions of the Mayo resident. He was making “fun” of the patient and sharing those photos with people who were not directly involved in the care of that patient again for the “look at this” factor.

    I have thousands of teaching photos and nothing in those photos can be used to identify the patient involved. I remember sitting in on a lecture by a nationally-famous trauma surgeon. One of the photos that he presented was of a gunshot wound in a patient who was in the middle of undergoing a sex change procedure. This is a rare procedure and the wound was fairly rare but he presented the photo such that the patient’s privacy was protected.

    A comment like “We are not violating the patient’s rights are we? ” is a pretty benign way to get your point across as students who are in the OR are there to learn and questioning proper procedure is legitimate and would require the person taking the photo to explain why they are following proper procedure.

    Had that resident followed proper procedure (incidently, Mayo Clinic in Rochester tapes many surgical cases), and only used that photo for educational value, this would not be a newsworthy item.

    Comment by drnjbmd | 8 January, 2008 | Reply

  4. >>>>>If you believe a patient’s rights are being violated, you have the right to speak up.

    Thanks for your quick response. But if the student did speak up, could they do it with confidence that their identity would be protected. Or would they have to challenge the ‘perpetrator’ directly in the OR about his misdeed? Wouldn’t that label the student as a troublemaker?

    If you were in the OR during mischievous photo taking, how would you have handled it?

    I don’t want to put you on the spot, but you’ve been wonderfully candid (and generous) in the sharing of your training experiences. I’m sure it’s appreciated by all who read your blog.

    Comment by Emily | 7 January, 2008 | Reply

  5. To Emily,
    Most patients who undergo surgery at teaching hospitals sign an operative consent form that allows them to be photographed for educational purposes provided their identity is not revealed. If they do not wish to be photographed, they will strike-through this portion of the permit.

    The use of photographs for educational purposes does not include snapping a photo with your cell phone and displaying it to your friends/co-workers outside of an educational conference. For what I can gather, this resident identified the patient and was not using the photo within the context of education but for comic purposes.

    If you believe a patient’s rights are being violated, you have the right to speak up. I always consider how I would feel if the patient involved was a loved one or me. Patient’s have the right to privacy and respectful treatment no matter what.

    Since I am usually the person who explains the procedure to the patient for obtaining consent, I go over the photographic paragraph very carefully. I also have the nurse check the permit before I take a photo just to be sure that the patient has indeed, given permission. I also make sure that there is no way the patient could be identified in any manner. Even at an educational conference, a patient’s privacy has to be respected. All identifiers are removed from radiographs, photos and records.

    Comment by drnjbmd | 7 January, 2008 | Reply

  6. Hi, thank you for such an informative blog. I am seriously considering a medical career. Regarding your paragraph on Legal Matters, I have a question about the recent news item of a resident getting in trouble when he photographed the tattooed penis of an anesthesized patient (in for gallbladder surgery) with his cellphone, apparently to share with colleagues outside the OR for laughs.

    What advice would you give the medical student or other OR personnel who witnessed this? On other medical blogs, there was great concensus that this was no big deal since the patient wasn’t harmed. In their view, the whistleblower was the enemy. If a medical student in the OR witnessed this or any other incident disrespecting a patient, should they risk jeopardizing their career, or just keep quiet? What would you have done?

    Here is a link in case someone hasn’t heard about this.

    http://jonathanturley.org/2007/12/19/respected-mayo-clinic-doctor-facing-lawsuit-for-photographing-patients-private-parts/

    or

    http://tinyurl.com/2gbeow

    Comment by Emily | 7 January, 2008 | Reply


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