The Benefits and Drawbacks of Shadowing
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Perhaps it is the particular time of year when med students start thinking about life after medical school, but I am fielding many requests for shadowing experiences. This has caused me to reflect on the practice and how it helps with determining career goals. Shadowing a physician is a common learning experience for junior medical students and is often built into the curriculum. (1, 2) It is an excellent way to observe physician-patient interactions with a role model and they can learn about specialty medicine. Other individuals who ask for such privileges are high school or college students and international medical graduates (IMGs). The high school and college students are also exploring medicine as a career choice and need such an experience prior to undertaking the arduous application process. In one survey, 80% of premedical students had had this exposure.(3) IMGs need contact with physicians in order to demonstrate exposure to the US medical care system or to update their medical knowledge. Being a casual observer in my workplace can make all the difference, it seems. What are the advantages to this practice and what are the drawbacks?
The advantages of shadowing are several fold. The trainee makes contact with a mentor who can guide them through the difficult process of career selection. Trainees can ask about lifestyle and other intangibles as well as observe the flow of a physician`s day. They learn the scope of the specialty. In their early years, medical students learn a good deal by observation prior to active practice. IMGs need the support of a clinician (especially a letter of reference) in order to navigate the US application process if they wish to retrain. Does shadowing/observership really help an IMG? I feel they do, indeed, learn about the US medical system by observation and IMGs are afforded the opportunity to see residents in active practice. Shadowing can be a source of inspiration to this particular population who must complete many extra steps in the application process. Since IMGs are restricted from actual patient care, this limits the content of the reference letter, however, since they cannot be observed in action.
What are the disadvantages of shadowing? For one, we have increased concerns about the privacy of our patients and their medical records. The majority of patients are incredibly gracious in allowing junior medical students to observe. For the most part they understand the necessity of the apprenticeship system in teaching hospitals. However, it is difficult to explain the role of other observers when their presence is of no apparent advantage to the patient. In fact, their presence might be a liability –with regard to physician-patient confidentiality and interfere with patient care or safety. Medical students are held to strict policies concerning patient privacy and professionalism but the same is not true of a visiting high school or college student. Another drawback is competition for time. As eager as I am to introduce students to the life of an anesthesiologist, I usually have residents to train and shadowing necessarily dilutes my attention (and energy).
Clearly shadowing is a mixed blessing for us all, but it is also a necessity for many reasons.
What are your thoughts about shadowing?
Resources
1. Kitsis EA: Shining a light on shadowing. JAMA 2011; 305: 1029-30 2.
2. Stoeckle JD, Ronan L, Ehrlich C, Roberts D: The uses of shadowing the doctor–and patient: on seeing and hearing their work of care. J Gen Intern Med 1993; 8: 561-3.
3. O`Connell VA, Gupta J: The premedical student: training and practice expectations. Med Educ Online 2006;11:1-12