Shadow Doctoring: Tips for Future Docs

10 05 2010

This Saturday, I rounded in the hospital.  I met up with Zainab, the president of the minority premed association for the University of Chicago, who asked to shadow me.  While she was doing research at the hospital, she had not ever rounded in the hospital before.  It was Saturday so our team was mostly off so it was just me and my very capable resident who is about to graduate and take a primary care job in the community. 

But, yesterday’s rounds was different and it was because Zainab was there.  Patients were excited to meet her giving her the thumbs up.  Medical students walked by and asked her if she was going into medicine and scurried away but said ‘definitely do it.’   My resident, in face, told her it’s a great career.   These positive endorsements were occurring in the middle of some difficult patient issues (one patient who wanted to leave against medical advice).  It is also May – meaning the students, interns, and residents are tired.   Even I felt energized as she was asking me about why I do this job and how I got here.

It was not the first time that I had taken shadower on rounds.  I run a program for high school students to get clinical exposure and research experience.  Interestingly, one of the high school students in the program was also in the hospital today interviewing a patient for one of the large studies we direct.  He looked so professional as he was preparing to go find a patient to interview for the study.  These students also shadow in the clinic and the hospital during the summer while they are doing research.  So, it had been about a year since I had a shadower with me. 

Shadowing is an important part of learning what being a doctor is like and doctors need to provide students opportunities to do so.  It is also a factor that medical schools consider at when making decisions about who to admit – does the candidate have an understanding about what a medical career is like?

So how do you shadow a doctor? Here are some quick tips for premeds looking to shadow.

  1. Leverage connections – Zainab found me through her other summer job where someone I work with through the College told her to contact me.  If you are on a college campus with a medical school, use your contacts through your premed office or via research opportunities.  If you are not on a college campus with a medical school, you could offer to shadow your doctor in your hometown or contact local hospitals through their volunteer or community affairs office to see if they have a shadowing program.
  2. Be flexible with when you can come – It may be the best time for you to observe is either early in the morning or during off hours, like weekends or evenings.   In the hospital, weekend rounds are sometimes easier to observe since many people are off so there are not as many learners on each team.  In addition, things are usually not so rushed since attendings don’t have to rush to clinic usually.  They may want to keep rounds short so they can get back to their weekend but they will probably appreciate that you are volunteering your time to do this on a weekend.
  3. Bring a notebook to take notes on what you don’t understand – I forgot to tell Zainab to do this so I gave her some paper and notes so that she could jot things down and afterwards we reviewed the questions one by one.  On rounds, doctors also use a lot of abbreviations so you may not be able to follow everything but you can jot these down and ask about them later.  Zainab later asked me what a “RTA” is to which my resident responded not to worry since he didn’t really understand renal tubular acidoses until this past year. 
  4. Wait to ask questions until rounds are over The focus of clinical encounters is the patient, not the student.  This is unlike routine classroom interactions and can be difficult to get used to but it is the reality of patient care.  Complex decisions are often being made and you don’t want to interrupt the doctor-patient conversation.  Remember you can ask not only about the medical jargon but about what else you observed.
  5. Wear comfortable closed-toe shoes and appropriate dress– This is very important since you may be on your feet for a while and its important to project a professional image as a visitor.  It’s also important that your shoes are not open-toed (sorry ladies) since your feet are at risk of coming into contact with equipment, body fluids, or sharps.  A helpful power point with some tips on dress here. 
  6. Reflect on your experience afterwards– During your medical school interview, you may want to recall your experience, the types of cases you saw or just generally how you felt.  Writing a short reflection on your thoughts is a good way to keep those memories fresh (but remember not to include any identifying information – see # 8).
  7. Don’t forget to follow up– Don’t forget that you were a guest on rounds so its good to follow up with a thank you for the doctor.  They may send more opportunities (shadowing or otherwise) your way if things went well.  Yesterday, I got a great thank you from Zainab and invited her and her group to a medical student research poster session open to the University community. 
  8. Respect patient privacy– There may be a patient who doesn’t want you in the room.  And remember, everything you see in the hospital is private and not to be repeated or written about in a manner that could lead to the identification of the patients involved.  If you aren’t already affiliated with the hospital in some capacity (i.e. doing research), some doctors and hospitals will require that you sign a form for HIPAA stating that you will respect patient privacy.

Good luck future docs and happy shadowing!

–Vineet Arora MD

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5 responses

10 05 2010
Colleen

I could not agree more with this advice. I did as much shadowing as I could before medical school, and it gave me tons to talk about in my interviews as well as dispel a lot of myths and misconceptions out there about medicine in the media, etc. It’s not always easy to set up, but certainly worth the effort!

12 05 2010
Louis Ling

It is terrific that Zainab had such a good experience because to my surprise, I have had a paradoxical negative reaction from some of the students who shadow with me. I think they come from two responses:

The first is that some students find it surprisingly tedious to follow me as I go from room to room and spend a long time talking to patients in the ED. I now realize that they do not have enough medical knowledge to understand the reasons behind my questions. For me, the hunt for a diagnosis and teasing out the nuances of the history of each patient is exciting, and the process of problem solving and sifting through the differential is rewarding, but to a lay person, the rationale for questions and the thinking process is not at all evident. They miss the entire thinking process and so it just sounds like random words and questions instead of carefully selected attempts at peeling away the layers to get to the truth. So while I feel energized and time flies through my shift, they get sore feet and tired.

The second response occurs when occasionally flashes of drama attendant with the requisite noisy presentation, invasive procedures, massive bleeding, messy body fluids and terrified family punctuate our day. I have had several shadowers faint get woozy or simply go blank. They typically have the aptitude to become fine physicians but suddenly lose their enthusiasm. They tell me that they have changed their mind because they can’t see themselves handling that blood, death or uncomfortable situation. I try to explain that most of us had similar reactions when we were younger but it took many years of college and life experience, medical school with simulations, clinical encounters and a long time of desensitization to get used to these situations and that they should not expect to easily handle those situations so early in their careers. By that time however, I can see the far away look in their eyes, the trace of doubt and fear and know that I have lost them. While they might nod at my explanation, their emotional response has overcome any logic or explanation that I can offer. I feel badly that a promising future physician may have given up on that dream because they were prematurely shocked into discouragement.

So I have been more careful who I take as a shadow now, screening for maturity and hardiness and a little deeper understanding of their growth process and where they are in their young career. And with each one, despite my warning lecture at the outset, I hope that it is not the last day of a young students aspirations.

27 05 2010
futuredocs

hi Louis, thanks for your thoughtful comments. I can definitely see how shadowing in the emergency room would be more chaotic and harder to follow -probably due to the volume of patients as well. I heard about this interesting Scribe program where college students are actually used to take histories in some community emergency rooms.

I would say that there are certain days in the hospital that feel this chaotic but because they are somewhat predictable (days where we are admitting patients for example), I have the luxury of avoiding shadow days at that time. Maybe there is a step up lesson here- first start of small and then progress to the emergeny room when you’ve had a few hospital shadowing sessions under your belt?

31 05 2012
Catherine

Thank you so much for this comment. I have been shadowing surgeons and working in the ER. A couple times I have found that I have to step out of the room for a while because I start to get light-headed or woozy when patients are in a lot of distress. I have definitely thought that maybe that is an indication that I may not be cut out for medicine, but I’ve gone back and tried again. It is so good to hear a doctor say that a lot of people experience the same thing and still become fine doctors! I’m hoping to desensitize sooner rather than later!

28 01 2012
iceman

Thanks, your post was really helpful and got me thinking. Thanks. Once again for The advice.

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