Medicine From The Trenches

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

Before you shadow…

As the new school year begins, I am receiving requests from premedical students about shadowing opportunities. I am happy to honor some of these requests and I am happy to pass some of them along to my colleagues so that as many students as possible get an opportunity for a shadowing experience. What can a pre-medical applicant do to prepare for a shadowing experience? I will offer some suggestions in this post. These suggestions are based on my requirements for shadowing and on some of the requirements of my practice institutions.

Do Your Homework

When you contact a physician (or physician assistant) for a shadowing experience, be sure to ask about dress requirements, paperwork and expected times of arrival. It is a good idea to contact the person (or office of the person) that you wish to shadow a minimum of a week in advance to make sure that all arrangements are in place. You want to have the best experience possible thus you need to ask about the schedule for the day, logistics of when and where you should arrive and what you should bring. Many places like for you to bring a copy of your resume (or CV), your personal statement (write one if you don’t have one ready) and a list of questions or goals for your visit. Remember, you are not going to a party where you are expected to be entertained, you are collecting valuable information as to your future career. Shadowing opportunities are become more difficult to obtain (patient privacy and liability concerns) thus you need to make the most of any opportunities that you can.

Be sure that you know something about the profession of the person that you expect to shadow. If this person is a physician, then you need know about the practice of medicine as it relates to this particular specialty. As a surgeon, I am not interested in hearing how you don’t like surgery but are only with me to get a letter of recommendation. I am likely not to write a letter of recommendation for a person who first, has no experience in surgery, other than perhaps as a patient, and who doesn’t understand that whether or not you become a surgeon, any physician needs to know something about surgery other than just not liking it. I don’t expect everyone to want to become a surgeon but I do expect every pre-medical student to have at least an intellectual interest in the practice of all aspects of medicine.

Do come into a shadowing experience with some knowledge of the process of entering medicine. Again, the time of the person who has generously allowed you to have this experience should be respected. If you have no idea of what you need, go to the AMCAS website and check out their Aspiring Docs pages. This should be the minimum knowledge in your possession before you seek shadowing experiences.  this page also gives you some ideas of what you may want to request from your shadowing physician at the conclusion of your visit.

Arrive Early

Most physicians arrive at their offices early in the morning. It goes without saying that you don’t want to be late. Do a “recon mission” and figure out traffic, driving directions, parking and the like. If something catastrophic happens, you also need to have a number where you can contact the person that you are supposed to meet. You don’t want  to be the reason for an entire day getting off to a late start. If you are unavoidably delayed, the person you are meeting may be able to reschedule or make arrangements for another person to meet you so that both of your days are not ruined. If you know that your experience is going to involve observation in the OR, be sure to arrive early enough to change into scrubs and other operating attire. It’s always better to be early and wait rather than have a busy professional waiting for you.

Proper Attire

Before you select that new outfit, keep in mind that most physicians wear business attire in the office. If you are a female shadower, wear comfortable shoes that you can stand and walk fast in. Ultra high heels with slick soles that clack on floors are not acceptable. You have to be able to keep up with the person that you are shadowing. Keep makeup, jewelry and perfume to a minimum as you may be in contact with patients who are ill. I remember a young lady appearing in platform heels and ultra-short suit with large hoop earrings ready to make rounds with my surgical team. Not only was she not able to keep up with us moving from room to room, her earrings made noise as she walked and she missed a great deal of the morning rounds experience because the rest of us were going to the next room while she was applying Band-Aids to the blisters on her feet. Moral of the story: wear comfortable, well-broken in shoes and clothing that will allow you to move. She was dressed fine for a business or law office but not for medical rounds. Minimally, wear low heeled shoes, comfortable suit (slacks) with shirt and tie (men) , comfortable blouse and jacket.  You may be given a lab coat to wear for the day so pick something that will go under a lab coat.

Follow Directions

One of my hospitals will not allow pre-medical students in the operating room but offers some of the best clinical experiences for shadowing students. If I am doing surgery at that particular hospital on the day that a student is shadowing, I have to abide by the rules of that institution. If you are at an institution that does not allow you in the OR, the you wait in the surgeon’s lounge until the case is over. I do try to avoid having shadowers if I am operating at that particular hospital. If you are allowed in the operating room, make sure you introduce yourself to the circulator, ask if this person is not pointed out. The circulator will tell you where to stand. The operative word here is stand though you may be given a stool to sit as long as you are far out-of-the-way. If you are standing, keep your arms folded in front of you or at your sides and don’t touch anything.  Most of the circulating personnel that work with me will make sure that you can see as much as possible. Eat breakfast, use the rest room and get something to drink before you enter the Operating Room. You can’t afford to be dehydrated or develop a case of low blood sugar just as the incision is underway. Often the anesthesiologist will invite the pre-medical student to sit at the head of the table. If this happens, again, keep your hands close to your sides and follow any directions. Last direction, if you feel faint, notify the circulator so that this person can take care of you quickly.  Fainting happens and most people know when they are going to faint. Just say something.

When I bring a shadower into the operating room, I usually introduce them to the circulator and to the anesthesiologist (anesthetist) so that everyone knows who you are and why you are there.  I usually give the circulator a card with your name and why you are there-for their records. The circulator will help you understand what is going on and will explain things once the case gets underway. Also, be aware that the patient on the operating table is our main concern so that you understand that we are not ignoring you but are performing patient care in a very specialized manner. When the introductory procedures are completed, scrubbing, anesthesia induction and other pre-operative procedures, people are willing to explain things. (Do keep in mind that I will have already informed the patient that you are present and sought their permission for you to be present.). Every patient has the right to refuse having unlicensed personnel in the operating room or clinic when they are being seen. Most patients are happy to be part of your experience but not all patients.

Keep in mind that sometimes things become tense  in any clinical situation. If this happens, move out of the way and allow anyone and everyone to handle the situation. There is nothing personal about this but we always have to be prepared for the unexpected. You may observe some things that are not planned and may be tragic. Under patient confidentiality rules, which many institutions will have you sign, you are not allowed to speak about anything that you observe.  The unexpected and the tragic are part of medicine more often than in other professions but keep in mind that the confidentiality and safety of the patient is our first and foremost job. We will get back to you as soon as the emergency has passed.

Take names!

Bring a card so that you can write down the names of everyone who was part of your experience. It’s a nice gesture to write a short note of thanks to the office managers, operating room personnel and others who have helped to make your day as informative as possible. Most professionals who are in health care are happy to provide information to people who are cordial and interested in joining their ranks. A short note of appreciation is very welcome and let’s them know that you appreciate what they do.

Enjoy yourself!

A shadowing experience is a chance to see health care professionals do their jobs. Enjoy the experience and learn as much as possible. Actual work in medicine is not like what is on the telly or in the movies but is fairly routine for us who are there every day. While things are never routine for the patient, they are our main focus. We are all happy to have you learn and join our ranks but keep in mind that we enjoy our routine days. The best surgical experiences for me are those where everything goes according to procedure and the patient’s outcome is excellent. Take in everything and don’t take any comments personally as that is never the case. Some people are stressed on any given day and may not be a cheerful as you would like but are capable of teaching you something new and exciting. Make sure that you are in a position to learn which is why you are there in the first place.

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9 August, 2013 - Posted by | application, medical school preparation |

2 Comments »

  1. I saw in one of your earlier post that you are a former Respiratory Therapist. I’m a current RT student with aspirations(RT pun not intended) of furthering my career in medicine. I’m constantly in an internal struggle of PA or MD. I love Respiratory but I love to learn and I love medicine and I want to learn as much as a I possibly can. I would love some insight on why you chose MD. Thanks so much!

    Comment by Mayci Griffin | 22 August, 2013 | Reply

    • To M. Griffin:
      When I entered medical school, I had a Ph.D in Biochemistry and Molecular Biology. I had worked as a contract RRT on an occasional holiday but I was not going into a program that was not at the doctorate level since I already had earned a doctorate. It would not have made much sense for me to obtain a masters-level or bachelors-level degree having already earned a doctorate thus I didn’t actually consider becoming a Physician Assistant.

      Comment by drnjbmd | 22 August, 2013 | Reply


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