Evidence-Based Shadowing?

[Mt Kilimanjaro]

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I read this story today on KevinMD that examines the ethics of pre-meds shadowing physicians.

http://www.kevinmd.com/blog/2013/03/physician-shadowing-harmful-patients.html

Although I'm not completely persuaded by the "unethical" argument made in this essay, it made me wonder if there is any evidence suggesting that pre-med shadowing of physicians is actually beneficial to anyone. Let's face it, most people who are shadowing physicians are checking an AMCAS box, not actually investigating the career with an open mind, so shadowing is hard to justify if it does any harm to anyone, even indirectly (via slowing down the physicians). Shadowing seems to be a fairly recent development, as most doctors I have talked to never shadowed a physician before they started medical school and many of them find it an unnecessary requirement.

Personally, I have done a bit of shadowing and have not found it nearly as helpful as this forum would lead one to believe. In my experience, information about how the health care system works is much better learned elsewhere and most physicians who are not your relatives or close friends are unlikely to be totally candid about the costs and benefits of the medical career.

Does anyone know of any studies or other evidence showing any benefits of shadowing?

 

[113]

I agree with you. I shadowed a couple docs and found it pointless.

An internist I tried to shadow actually just straight up asked me if I needed a rec letter over the phone. He was willing to email me a generic rec without doing any shadowing.

 

[Lamel]

When I first shadowed it really solidified that I would love medicine. I was excited and enthused the whole day. So it CAN be useful. But I think shadowing a doctor for more than a few days is kind of pointless.

 

[eggs13]

getting to see surgery was well worth it to me; however, it did get kind of old standing awkwardly in the corner when shadowing in clinic.

 

[ComfortCreature]

When I first shadowed it really solidified that I would love medicine. I was excited and enthused the whole day. So it CAN be useful. But I think shadowing a doctor for more than a few days is kind of pointless.

Agreed. I've enjoyed my shadowing experiences. Required shadowing or some amount of exposure to the field seems pretty common, especially in health care. I know many PA, PT, and OT programs require some shadowing and/or clinical exposure.

 

[anguisette]

I learned a lot more from shadowing than I did from volunteering, but I can see how it'd be a ymmv kinda deal. I ended developing pretty good relationships with the doctors I shadowed regularly. It really helped me to see the patient-doctor interactions up close and in different settings. Also, my doctors were all very candid about what they liked and didn't like about the profession.

 

[amazing tekkers]

I think patients will certainly want you out of the room during a pelvic exam. how awks

 

[amazing tekkers]

I agree with you. I shadowed a couple docs and found it pointless.

An internist I tried to shadow actually just straight up asked me if I needed a rec letter over the phone. He was willing to email me a generic rec without doing any shadowing.

It's not pointless. Those doctors were probably just lazy.

 

[Amba]

It's not pointless. Those doctors were probably just lazy.

Agreed.

My shadowing experiences have been great, even if they were a bit awkward at times. I can't imagine shadowing a random physician more than once or twice, though.

 

[mimelim]

I agree with you. I shadowed a couple docs and found it pointless.

An internist I tried to shadow actually just straight up asked me if I needed a rec letter over the phone. He was willing to email me a generic rec without doing any shadowing.

It didn't strike you as odd that he did that? Lazy++

 

[nysegop]

Still, you need to have at least some clinical exposure. Otherwise how do you know you would like medicine?

 

[113]

It didn't strike you as odd that he did that? Lazy++

I'm not sure about lazy. If he were truly lazy, he could've easily ignored me. It sounded more like he was doing me a favor. Anyway, I ended up shadowing someone else.

 

[goofball]

The article is a load of bull.

In my shadowing experience, I had to get explicit consent from the patient to even be allowed into the room. Even then, the patient could withdraw consent any time they wanted (and they did! Once when I shadowed a pediatrician, a girl pointed at me and cried, and out I went!), and I would have to leave the room and play Angry Birds.

There's no ethics jam here.

 

[duhyesorduhno]

How do all of you people have some much experience shadowing? I've been trying to shadow for some time and I cannot seem to find anyone who is receptive. It is so annoying that I know no physicians personally. People always give me a generic brush off (shadowing is for med students, HIPPA, etc).

Did you guys cold-call or email people?

 

[113]

How do all of you people have some much experience shadowing? I've been trying to shadow for some time and I cannot seem to find anyone who is receptive. It is so annoying that I know no physicians personally. People always give me a generic brush off (shadowing is for med students, HIPPA, etc).

Did you guys cold-call or email people?

I shadowed docs at the same hospital where I volunteered. HIPAA issues were already taken care of through volunteer training/paperwork.

 

[duhyesorduhno]

I shadowed docs at the same hospital where I volunteered. HIPAA issues were already taken care of through volunteer training/paperwork.

How long did you volunteer until you shadowed someone?

 

[def1]

Shadowing is okay but i think there are much better opportunities to get acquainted with the medical setting. For me volunteering in hospice was 10x more helpful than shadowing ever was.

Though when I shadowed a neurosurgeon, it pretty much left me in awe for the whole day.

 

[McNCheese]

How do all of you people have some much experience shadowing? I've been trying to shadow for some time and I cannot seem to find anyone who is receptive. It is so annoying that I know no physicians personally. People always give me a generic brush off (shadowing is for med students, HIPPA, etc).

Did you guys cold-call or email people?

I used my school's alumni database to find alum physicians in the area. The alumni I contacted were all very receptive to letting me shadow.

I really enjoyed my shadowing experiences, but I might have just gotten lucky with the physicians I was shadowing. They were very candid with me and willing to teach. They were also very respectful of the patients' privacy - they would have me wait outside of the room while they asked the patient about me observing.

 

[alpinism]

With regards to research, i'm not sure there is anything significant out there.

What do you mean by is shadowing beneficial to anyone? There are so many reasons why its important to shadow: http://www.uwmedicine.org/education/md-program/admissions/applicants/pages/shadow.aspx

How else are you supposed to learn what being a physician is really like? What else would you suggest, TV/books/internet? For the most part, none of those are very realistic at all. They're made for entertainment and don't give you a glimpse into an average physician's daily life or the types of patients they see.

Also, shadowing is kinda like 3rd yr in medical school, you only get out of it what you put into it. If you're just standing in the corner, not paying attention or asking any questions then of course you're gonna be bored and not get anything out of it. Be assertive and engaging. Talk to them about their patients, hours, lifestyle, pay, likes/dislikes, regrets, etc...

 

[wonderdog]

When I first shadowed it really solidified that I would love medicine. I was excited and enthused the whole day. So it CAN be useful.

this. every single day I spent shadowing only reaffirmed my commitment to medicine.

every.single.day.was.worth.it.period.

 

[NickNaylor]

this. every single day I spent shadowing only reaffirmed my commitment to medicine.

every.single.day.was.worth.it.period.

I agree - but your experience varies with the physician you shadow. I think people that say "shadowing is worthless lol" either 1) had a terrible mentor or 2) don't understand the purpose of shadowing. No, shadowing isn't the most exciting thing in the world, but it's absolutely critical if you take the idea that you should know what you're getting yourself into seriously. Without my shadowing experiences there's no way I would've had any confidence in my decision to become a physician.

 

[Doctor Strange]

My shadowing was awesome. I clocked like eighty hours in the OR. My physician even took time after his clinic hours to just talk to me about healthcare and current issues and trends. It all depends on who you're shadowing.

 

[Mt Kilimanjaro]

With regards to research, i'm not sure there is anything significant out there.

What do you mean by is shadowing beneficial to anyone? There are so many reasons why its important to shadow: http://www.uwmedicine.org/education/md-program/admissions/applicants/pages/shadow.aspx

How else are you supposed to learn what being a physician is really like? What else would you suggest, TV/books/internet? For the most part, none of those are very realistic at all. They're made for entertainment and don't give you a glimpse into an average physician's daily life or the types of patients they see.

Also, shadowing is kinda like 3rd yr in medical school, you only get out of it what you put into it. If you're just standing in the corner, not paying attention or asking any questions then of course you're gonna be bored and not get anything out of it. Be assertive and engaging. Talk to them about their patients, hours, lifestyle, pay, likes/dislikes, regrets, etc...

I mean "is there evidence that people who shadowed are more aware of their career options or less likely to regret their decision or happier as physicians than people who didn't shadow." Any evidence that shows a clear benefit beyond confirming a decision that was likely made in high school or earlier? For the individual applicant this confidence might be a useful outcome, but not an absolute requirement for a rewarding career.

I'm not saying shadowing is bad. I think it can be great, but it is tainted by confirmation bias and, unless you do thousands of hours of shadowing, offers a very limited look at a huge, diverse field. Someone could shadow for many hours in FM, GenSurg, and the ED, hate all of them, still go to medical school, and find their niche somewhere else. It's nearly impossible to fully know "what being a doctor is really like" because there are so many different specialties and practice environments. However, I think the field is vast enough to absorb almost anyone, even people who hate seeing patients, so I'm just saying that it is prudent to have some evidence of long-term usefulness before throwing up another hurdle that is higher for applicants from certain socioeconomic backgrounds than for others.

 

[circulus vitios]

getting to see surgery was well worth it to me; however, it did get kind of old standing awkwardly in the corner when shadowing in clinic.

I thought it was more awkward when the physician tried to include me in the exams or asked me questions.

 

[HSUReddie]

My shadowing has been one of the highlights of my pre-med experience.

I had a summer intern gig at a major children's hospital. They arranged for us to shadow in pretty much any department we wanted. I did most of my hours in infectious disease and the ER. The ER doc was very concerned that I get something out of the experience - was always explaining things, let me help set a splint, cut excess off of stitches, etc. The main infectious disease physician I shadowed is probably the biggest physician mentor I've had, the chair of pediatrics, and an alum from my undergraduate institution. We still keep in touch.

I'm also currently completing my public health practicum at a children's hospital in the ID clinic, specifically with quality of care of the HIV patients. I shadow quite a bit too. The residents have been great about offering tons of advice since they found out I had been accepted.

Shadowing isn't pointless. Or dumb. Just have to land quality opportunities.

 

[Silo004]

Someone could shadow for many hours in FM, GenSurg, and the ED, hate all of them, still go to medical school, and find their niche somewhere else. It's nearly impossible to fully know "what being a doctor is really like" because there are so many different specialties and practice environments. However, I think the field is vast enough to absorb almost anyone, even people who hate seeing patients, so I'm just saying that it is prudent to have some evidence of long-term usefulness before throwing up another hurdle that is higher for applicants from certain socioeconomic backgrounds than for others.

Word.

I tend to follow this line of thinking -- that shadowing someone for a few hours "confirmed" a professional leaning is strange to me. How many pre-meds actually have the opportunity to shadow a Pathologist? More than likely, you shadowed a primary care physician. How many of you actually want to go into primary care? Or even better, how many physicians will be in primary care when you actually are a physician in 20 years?

I get the sneaking suspicion that shadowers, having checked the shadowing box, extol the virtues of shadowing because they are leaders in the box-checking race that is the MD admissions process.

Don't get me wrong though, not checking these boxes will put you on waitlists.

 

[ragnarokx]

The best way to get a meaningful shadowing experience is to make the shadowing secondary to what you're actually doing. For example, being a scribe gives all the same clinical exposure as plain shadowing, but you're actually doing something useful and engaging as your primary reason for being there.

 

[Premedengineeer]

I just started shadowing today. I just started calling doctors and one of them returned my call and he was like yeah sure you can come "hang out" with me whenever you want. He is even trying to find me an internship at the hospital. He is awesome.

Sent from my PC36100 using SDN Mobile

 

[wonderdog]

...your experience varies with the physician you shadow...

I would recommend talking to other healthcare professionals that you know and find out who is a good mentor.

 

[NickNaylor]

Word.

I tend to follow this line of thinking -- that shadowing someone for a few hours "confirmed" a professional leaning is strange to me. How many pre-meds actually have the opportunity to shadow a Pathologist? More than likely, you shadowed a primary care physician. How many of you actually want to go into primary care? Or even better, how many physicians will be in primary care when you actually are a physician in 20 years?

I get the sneaking suspicion that shadowers, having checked the shadowing box, extol the virtues of shadowing because they are leaders in the box-checking race that is the MD admissions process.

Don't get me wrong though, not checking these boxes will put you on waitlists.

While the point about shadowing in specialties you may or may not be interested in is legitimate, I don't think that means shadowing is now entirely useless. I think the exact approach that you mentioned - seeing it as an activity that must be done rather than an opportunity to, you know, gain some useful knowledge - is why people find shadowing useless.

Sent from my SAMSUNG-SGH-I717

 

[climbouthole]

While the point about shadowing in specialties you may or may not be interested in is legitimate, I don't think that means shadowing is now entirely useless. I think the exact approach that you mentioned - seeing it as an activity that must be done rather than an opportunity to, you know, gain some useful knowledge - is why people find shadowing useless.

I agree except with the bold. You don't need to shadow each and every specialty to make the exercise beneficial to understanding the practice of medicine, especially if you shadow in an inpatient setting. Sure you may only shadow an infectious disease doc, but you see all the other doctors and nurses and techs doing their jobs too. You get a real look at the system and can better "use your imagination" if you really want to think about one particular specialty you haven't shadowed. But again advice is typically don't enter medicine for one specialty, it's better to be attracted to the entire system (which absolutely yes has many, many variations).

 

[alpinism]

I mean "is there evidence that people who shadowed are more aware of their career options or less likely to regret their decision or happier as physicians than people who didn't shadow." Any evidence that shows a clear benefit beyond confirming a decision that was likely made in high school or earlier? For the individual applicant this confidence might be a useful outcome, but not an absolute requirement for a rewarding career.

I'm not saying shadowing is bad. I think it can be great, but it is tainted by confirmation bias and, unless you do thousands of hours of shadowing, offers a very limited look at a huge, diverse field. Someone could shadow for many hours in FM, GenSurg, and the ED, hate all of them, still go to medical school, and find their niche somewhere else. It's nearly impossible to fully know "what being a doctor is really like" because there are so many different specialties and practice environments. However, I think the field is vast enough to absorb almost anyone, even people who hate seeing patients, so I'm just saying that it is prudent to have some evidence of long-term usefulness before throwing up another hurdle that is higher for applicants from certain socioeconomic backgrounds than for others.

I agree, It would be nice to have some studies to look at the impact of shadowing on applicants perceptions and expectations of medicine.

Per the bolded, while each particular field in medicine is certainly different and unique (and it's impossible to shadow in every environment/field), there are common themes seen in nearly every field that all applicants should be aware of prior to applying. For instance, nearly all docs spend wayyy more time doing paperwork than actually seeing patients. Its a huge pain in the butt. Then there is all the haggling that goes on w insurance companies and trying to get them to cover your treatments. Often times they won't. What is medicare and medicaid, how much do they reimburse you. How do EMRs work and what types of info get put into them. What are call schedules like and what is it like being on call. When do you refer a patient or call in a consult.

No matter what field/environment you end up practicing in, the vast majority of the time you'll have to deal with the above on a daily basis.

If you hate seeing patients, its gonna suck even if you're only interested in path/rads. You'll still have to see patients all 4yrs of med school and during residency when you'll be doing rotations in different specialties (no, rads residents don't just do radiology). That's a minimum of 5-6yrs where you'll be constantly seeing patients. On top of that, even as an attending, most of the time in those fields you'll still have to see patients occasionally.

Basically, the point of shadowing is to clear up any misconceptions you might have about medicine as a whole and to help you to make an informed decision. If you shadow in multiple fields it can also help you to compare different fields and to see what interests you.

 

[OCDOCDOCD]

I think that shadowing has minimal benefits. It's a very passive activity, and most of the benefit that you could gain from it is lost on a pre-med since they have no idea what they're observing.

The usual argument presented for shadowing is that it "helps you know what you're getting into" but then try to claim that you now know what you're getting into and then you'll be told that no matter how much clinical and shadowing experience you have, you can never know what it's like to be a physician as a pre-med. 😕

Personally I've found shadowing to be pretty interesting, but at the same time I have to admit that I don't see much pedagogical or practical value in it. I think the only reason it's even desired by med schools is because out of all the things they can require of a pre-med, shadowing has the most face validity. And really that's a problem inherent with med school admissions; beyond standard admissions material (GPA, test scores, LORs, essays), what truly relevant, significantly predictive metrics can you hold an applicant to?

Anyway, the ethical issues with shadowing have occurred to me before, and pretty much occur every time I'm shadowing really. Is it really okay for me to be watching a gynecology exam? Should I be in the room when a woman talks about how she was sexually abused as a child and explains how that's created a bunch of issues that are now affecting her health as an adult? All of this would be fine if I were contributing something or were it giving me significant training experience, but in reality I'm not really sure what benefit there is to me being there for all of that. The only reason I go along with it is because I know I'm not going to share anything I see with people outside the examination room.

 

[Mt Kilimanjaro]

To answer my own question, there was an article in Academic Medicine earlier this year that reviewed the literature about pre-med shadowing.

http://journals.lww.com/academicmed...hadowing___A_Review_of_the_Literature.31.aspx

The conclusion: "Although shadowing is generally valued
by participants, its impact has not yet
been clearly demonstrated. The dearth of
studies on shadowing and the variability
of programmatic goals, processes, and
participants make it difficult to determine
its effectiveness."

 

[amad01]

Still, you need to have at least some clinical exposure. Otherwise how do you know you would like medicine?

This is something I don't really agree with... it's as if we have no idea what we are getting ourselves into until we shadow a physician...😕 What other careers outside of medicine do students "shadow" professionals in their field? Pre-Law students go sit with lawyers? Engineering students go watch engineers? Art students watch painters paint?

Really I see shadowing as getting a more in-depth look at different branches of medicine to learn more about them, rather than a make-or-break process for career choice since I'm too ignorant to understand a physician's job description.

 

[Mt Kilimanjaro]

Really I see shadowing as getting a more in-depth look at different branches of medicine to learn more about them, rather than a make-or-break process for career choice since I'm too ignorant to understand a physician's job description.

The primary purposes of shadowing seem to be 1) exciting yourself about medicine and 2) finding what specialty most appeals to you. But there's no evidence that all the time and ethical issues produce any long-term payoff whatsoever. Specialty choices can and should be made in medical school.

It's part of a troubling trend of the medical curriculum creeping into the pre-medical years. The net result forces people to commit to medicine even earlier and limits the time available for non-pre-medical experiences during college.

 

[NickNaylor]

The primary purposes of shadowing seem to be 1) exciting yourself about medicine and 2) finding what specialty most appeals to you. But there's no evidence that all the time and ethical issues produce any long-term payoff whatsoever. Specialty choices can and should be made in medical school.

It's part of a troubling trend of the medical curriculum creeping into the pre-medical years. The net result forces people to commit to medicine even earlier and limits the time available for non-pre-medical experiences during college.

Ethical issues? Like what?

 

[LizzyM]

All of you are, I presume, applying to medical school. What you don't hear here are the voices of those who have shadowed, realize that the reality of medicine as a career is not even close to what they imagined, and they make other career plans.

Yes, it hapens. It is certainly better to have it happen before one applies and is admitted and borrows thousands and spends months/years in medical school.

 

[trs88]

Pre-Law students go sit with lawyers?

Just wanted to be a butt about this, but yes. I work in a prosecutors office (part time clerk) and we have interns of varying "grade" levels. One or two getting their bach degree and the others are all in law school. Depending on how far along they are, pre bar exam - post bar exam, equaled the work that they could be assigned and completed. I was personally assigned a student in high school that wanted to go into law. I didn't care for him all that much, he would finagle out of every opportunity to watch the prosecutors in court and just wanted to hide somewhere and play on his phone.

I volunteer at the local ER and because I am able to shadow so many different MDs (each week was a different doctor) I was able to learn which doctor the medical staff liked or disliked and why. Not that I will mention it during an interview, if invited, but when shadowing the disliked doctor I made mental notes to not do what made the medical staff dislike the MD.

 

[Mt Kilimanjaro]

Ethical issues? Like what?

The authors of the article I posted state it better than I can. But I think shadowing often results in misleading patients. I have always been introduced as a "student doctor," "doctor-in-training," or someone who's "working with me today." None of these are clear about my status as "some random person who may or may not be a doctor some day."

No matter how much we try to convince ourselves otherwise, anybody who walks into a patient's room with a physician wearing business casual will be assumed to be a medical professional unless it is explicitly stated that they are not. Maybe this isn't a huge deal, but it's misleading nonetheless.

 

[Mt Kilimanjaro]

Yes, it hapens. It is certainly better to have it happen before one applies and is admitted and borrows thousands and spends months/years in medical school.

I agree with this, and I think some shadowing is useful to determine whether or not the vast field of medicine is right for you. Beyond that, you're essentially doing a pre-med preceptorship in fields that you are interested in. The field is so broad, almost anyone who can graduate from medical school can find their niche somewhere. It seems to me is that schools are gradually expecting a much more nuanced understanding of the various specialties and career options than is probably necessary for a rewarding career in medicine.

I also think it's interesting that the AAMC's Careers in Medicine portal, which is aimed at helping students pick a specialty, is not even available to pre-medical students. I think reading this portal would provide a lot more useful information about the field as a whole than spending a day with a single physician with his/her own biases and opinions.

 

[NickNaylor]

The authors of the article I posted state it better than I can. But I think shadowing often results in misleading patients. I have always been introduced as a "student doctor," "doctor-in-training," or someone who's "working with me today." None of these are clear about my status as "some random person who may or may not be a doctor some day."

No matter how much we try to convince ourselves otherwise, anybody who walks into a patient's room with a physician wearing business casual will be assumed to be a medical professional unless it is explicitly stated that they are not. Maybe this isn't a huge deal, but it's misleading nonetheless.

I guess I don't really see the problem. You will be having exactly zero impact on their care. The only somewhat reasonable ethical issue I see is that patient privacy is being unnecessarily violated for no real reason other than someone wants to apply to medical school.

It's not as if a shadowing student is being introduced as a medical student or physician and then examining or otherwise interacting with a patient. You are being introduced and then, most likely, you will do absolutely nothing for the remainder of the encounter. I don't see what the problem is.

By the way, if this is bothersome, you're going to **** your pants when you get into med school. I assure you there are significantly more legitimate ethical issues associated with training medical students than a premed student standing in an examining room.

Sent from my Nexus 7

 

[Pons Asinorum]

By the way, if this is bothersome, you're going to **** your pants when you get into med school. I assure you there are significantly more legitimate ethical issues associated with training medical students than a premed student standing in an examining room.

This. 100x this.