Medical M2 did not attend mandatory shadowing sessions, how do I talk to my course director about this

[Mr.Smile12]

I'm currently an M2 at an MD school. We have two class series running simultaneously in year 2, a pathology/treatment class and a clinical doctoring course. One of the requirements of the clinical doctoring course is to schedule and attend 6 shadowing sessions with a physician you have been assigned to work with. I did not do these, and I am meeting with my course director about this next week. I need advice about how to explain the situation to her and best plead my case for an opportunity for remediation.

We had to do the same shadowing in M1, and I was assigned the same doctor to shadow this year. However, I did not have a good experience with this doctor, and I dreaded going into the office with her again. One issue was that she only saw cases of a very specific specialty, and that specialty was not one that was very conducive to teaching preclinical medical students. I kept hearing about my friends getting to do tons of interviews and even some procedures (!). Most of them were in internal or family, but some were in ENT and other specialties and they still seemed to get to do things in their shadowing. Instead I stood behind my physician for 4 solid hours just watching her. We had some basic requirements to complete during shadowing (cards and pulm exam, abdo exam) and in order to get those exams done, the doctor had to shoehorn those in on sick patients who basically had no reason to have me poking and prodding at them (this physician's patients all had issues with one very specific organ). The patient to patient difference in the sequence of her interview and exam were largely the same (particularly since all of them were long term patients of hers) and the actual clinical difference in their presentations were down to details I don't think I could possibly understand without getting a fellowship in the field. Because of this, it felt like I was learning very little from session to session.

The thing is, there was nothing wrong with HER, she was a great doctor. But I was (at the risk of sounding petulant and entitled) kind of miserable shadowing with her. I really wished I had been assigned to someone in internal med or ANYTHING else.

Having been assigned to more shadowing sessions with her this year, I basically procrastinated on scheduling them with her since I dreaded them so much. Every other part of my education seemed more important, enjoyable, and... educational. The more I procrastinated on scheduling, the more irrationally anxious I became about "bothering her" so late in the semester. Eventually I did email my preceptor late in the semester about completing the sessions but she never responded to my email. It took me so much effort to grit my teeth and send that email, I was so defeated by her lack of response that I just ran out the time allotted to do these sessions. Now I'm meeting with the course director about why I haven't completed these sessions. Basically, part of this is due to my really disliking my preceptor, but it could all be solved if I had requested a preceptor change early enough in the semester. Why didn't I do this? I'm not sure. I think it's partly because of a generalized anxiety I have of offending or bothering people who are my professional seniors. I didn't want to say "I am unsatisfied with my preceptor" because that would be incredibly presumptuous of me. Of course my extreme avoidance of the situation was much much worse.

I realize this has revealed an issue for me that may rise to the level of a legitimate mental health problem. I've had this "social anxiety with contacting people in positions of seniority over me" before with teachers and mentors, but it's caused problems in the past, but never to this extreme degree.

I'm meeting with the course director next week to ask her to let me remediate the sessions. If I can't, I imagine this will be a fail in the course and I don't know if I should be worried about dismissal or something like that at this point. I do know you have the chance to remediate failed exams. But the syllabus is unclear as to how missing mandatory but ungraded sessions is managed in terms of remediation. Additionally, I don't know if this is enough of a lapse of professionalism to bring the question of dismissal to bear.

At the end of it, how much of this whole internal struggle should I relay to course director when I meet with her and what would be the best way to approach asking her for a chance to remediate these sessions? Thank you for your help!

Did you actually talk to your student dean about this in advance? Did you seek any counseling or psychological help? Self-diagnosis without confirmable, documented actions is no excuse for "mandatory" meetings or tasks. Review your student handbook on this situation and what recourse you may have.

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I do not have a diagnosis and I'm not seeking to use mental health as an excuse for my actions. What I've written is only my introspective analysis on why I made the mistake I did. In light of this, I'm looking for advice on how to approach explaining the situation to my course director, and requesting an opportunity for remediation without a "legitimate excuse".

I am worried because the student policies are unclear about the situation of failing a course because of missing mandatory non-graded sessions rather than failing because of a poor grade. Failing a single graded class in a year is "fine", in as much as you can remediate it with an exam. Would you suggest talking to student affairs about this prior to the scheduled meeting with my course director? I suppose I am lacking information.

I am also currently attempting to schedule an appointment with student behavioral services for my own sake, so this doesn't happen again.

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[Goro]

I can't sugar coat this.

1) You're going to have to own this.
2) Any attempt to make excuses will only come off as that.
3) It was your responsibility to contact the course coordinator ASAP and try to find a different doctor to shadow. Saying "I didn't want to say "I am unsatisfied with my preceptor" because that would be incredibly presumptuous of me." is not the mindset you should have.
4) Failing that, you should have gritted your teeth and done the assignment. It WAS your responsibility to do it.
5) You will help yourself if you can come up with a remediation plan, AND an outline of steps you will take in t he future to assure that this will never happen again. And I guarantee you that you will have not just shadowing experiences, but entire rotations which will be unpleasant. It will be your responsibility to make the most of them.
6) You're now on your school's radar. Pull a stunt like this again in your clinical years, and they might very well dismiss you.

 

[MusicDOc124]

I'd also be weary of what you're comparing things to. For instance, no one should expect much more than glorified shadowing as an M2 as you're there for what, a few hours tops? Maybe a few random days? And you havent finished your didactic education yet.

Your classmates saying they did procedures may be telling the truth, but they more likely are exaggerating in that someone probably put the leads of an EKG on someone, and another may have learned to do an IV.

Just be careful of what you hear and try to compared your experience to.

That said, as stated above, this is on you. You did not contact someone after the previous experience, or when assigned the same preceptor to have it change, and than chose to not go without informing anyone.

There is also a lot to be learned through observation, btw. What exactly was bad other than being limited to observation?