Shadowing EM DO next week, have a few questions.

[chudat]

So I'm on winter break right now and I am going to shadow an osteopathic emergency physician next week. What should I prepare beforehand? Do you guys have a list of suggestions/questions or any other tips? I want the experience to be meaningful and not a day of silence/awkwardness.

Brief background: He went to UNECOM and did his EM residency in an allopathic program. He's been practicing for 2 yrs.

What is the appropriate attire? I'm thinking khakis and button down.

Lastly, how should I ask for a letter of recommendation? Since I'll be going back to school the week after, I need the letter before I go. Will he write a good letter in such a short time? Also, what kind of materials did you give to the physician in facilitating the process. A resume? Personal statement? Activities list? Schools like LMU-DCOM and VCOM have separate evaluation forms. Should I give those to him too? I don't want to inundate him with more paperwork than he probably already has. Lastly, should I send him a thank you card afterwards?

Sorry for the long post, but I'm a little nervous for the shadowing. Thanks.

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[Bacchus]

I didn't use VCOM's form. As I remember, it was to be used if the physician didn't want to write a letter.

 

[engineeredout]

Doctors get busy so you might find yourself waiting more than a week for a letter.

The evaluation forms/wavers don't seem to matter that much.

Definitely have with you a copy of your resume/CV and personal statement so if the doctor wants to write the letter he'll have some source of information with which to embellish the letter and make it sound like he actually knows you.

As for dress it depends on the location. You're never going to go wrong with a button down shirt and tie, and if hes an attending odds are he'll have the same thing. For me personally I did shadowing at the same hospitals that I did volunteer work at, so the docs just had me wear my volunteer jacket and kackis.



For the actual shadowing, make sure you carry around a pen and paper so that if you're watching him with patients you can write down questions and ask them when hes finished. Try and find out what you can about the various cases. ex: "Why did you perform X test? What do you hope to see with Y?"

 

[DrRoast]

My first DO shadowing experience was an EM Physician at a level I trama center. It was very fast paced and I didn't have a lot of time to get to know me. I shadowed him about 50 hours and still didn't feel comfortable asking him for a letter, so I found a Family DO to shadow. Anyway, I don't think the above posters idea about bringing a pad of paper is necessary at all, in fact I think it will be distracting. If it was anything like my experience your not going to have alot of time to ask questions anyway, so just remember things you really want to ask. Your plan for attire is just fine, in that mostly everyone in an ED today is in scrubs. If you plan on asking him for a letter, definitely have your CV and PS available, I'm sure he/she would be willing to help. You definitely don't need the forms for any school, they will all (I think) accept a written letter as it is more personable. Also, if he/she did an allopathic residency your not going to see anything uniquely osteopathic, just keep that in mind if this is something you wanted. Best of Luck

 

[Flushot]

About the LoR request: some people recommend outright asking for a letter so they clear the air so to speak and also for the physician be aware that he/she might have to get to know you a little better. It's a possible option.

Also, be prepared to be told to write your own LoR and he/she will review it. This is what happened to me and although my doctor ended up rewriting 90% of it, I still had to show up with something.

 

[DrMom]

Call the doc to ask about attire. Most likely they'll recommend scrubs...if you don't have any you may be able to borrow a pair from the hospital. If not, khakis are good.

EM can be fast paced depending on what comes in. You'll likely have questions, so just let him know if you do so that he can answer them when he gets a chance. If he's in the middle of things he may not be able to answer right then.

 

[chudat]

Do you it will be that busy even though he's working a morning shift?

I feel like if I ask him right away about the letter, it makes me look like only wanting the letter so I can apply to schools and not because I truly want to learn.

Do you guys have any suggestions as far as questions go?

 

[doctor712]

Hey. I agree with most of the posters on advice. Though, I'm not sure I would call the doc about attire. I never really want to ask the guy/gal I'm trying to impress these sorts of professional questions. I'd wear shirt and tie and on day two if u need to change you'll be told. GOOD LUCK AND ENJOY THE TIME IN ER!

 

[bleeker10]

I also shadowed a DO in the Emergency Department. I asked him what I should wear and just ended up wearing a long sleeve button up with khakis and dress shoes. I brough a note pad to write on, but didn't end up using it because we were pretty busy. I was able to ask questions when the physician sat down to order lab tests and write progress notes on the computer. I just made sure that when he was typing, I didn't ask any questions. He was really laid back and told me to call him by his first name (I always called him Dr. X just to be professional and respectful). I asked about his views on osteopathic medicine, osteopathic schools vs allopathic schools, OMM, emergency medicine, and modern healthcare. I was able to watch many procedures, including suturing of a laceration and pregnancy exam for possible miscarriage. During the pregnancy exam, I stayed out of view of the pelvic area and made sure I was at a distance to not seem intrusive. If you think the physician is seeing a patient about a sensitive area (genitals, breast, rectum), just ask the physician, if possible, if he/she thinks you should be in the room and where to stand. Just remember to stay out of their way because they are very busy and do not interrupt anything. Ask questions when there is a little bit of downtime. Also, don't expect to see horrific traumas or codes being run. Most of the patients I saw had abdominal pain or migraines trying to get narcotics.

As for the letter, I asked the physician when I was done if he would write me a letter. But I told him I would shadow more so he could get to know me better. I gave him my CV/resume and all the info needed to send the letter to Interfolio including a pre-addressed and pre-stamped envelope.
Just have fun and pay attention to why ED waiting times are so high.

P.S. I was able to see a manipulation performed on a patient with chest pain. It turns out the patient had a loose rib and this may have been causing the pain, but more than likely it was something else. Ask the physician if they perform OMM at all and if so, how often.

 

[RySerr21]

Do you it will be that busy even though he's working a morning shift?

I feel like if I ask him right away about the letter, it makes me look like only wanting the letter so I can apply to schools and not because I truly want to learn.

Do you guys have any suggestions as far as questions go?

i shadowed a physician for an entire summer, and the next spring (March) I told him that I would be applying next cycle and that I needed a letter. I didnt get it until late June. So, don't expect a quick turn around time. Its all hit or miss. Ive had other docs write them in a week. So, just konw that you never know how fast the turnaround time will be. I dont see why you need it before you leave for school. He can always fax it, or upload it onto interfolio. You technically aren't supposed to see the LORs.

As far as questions, i doubt he expects you to come with specific questions about EM. You could ask him about his experience in medical school and residency...maybe what his hardest year of medical school was? I dunno, i always think those questions are interestig. You could ask him how he feels about OMM, especially since i'm guessing he never uses it as an EM doc. You can also just ask questions regarding the stuff you see in the ER...show that you are interested in what you see and are trying to learn.

Theres no pressure. It can be whatever you make of it.

 

[DrMom]

Hey. I agree with most of the posters on advice. Though, I'm not sure I would call the doc about attire. I never really want to ask the guy/gal I'm trying to impress these sorts of professional questions. I'd wear shirt and tie and on day two if u need to change you'll be told. GOOD LUCK AND ENJOY THE TIME IN ER!

I'm an ED resident. You'd look stupid if you showed up into the ED in a tie. This is a messy place and the vast majority of the docs wear scrubs. I think it looks better to ask in advance than show up in something 100% inappropriate.

Now shadowing in an office or with a hospitalist...a tie is most likely appropriate.

 

[kdstephy]

I'm an ED resident. You'd look stupid if you showed up into the ED in a tie. This is a messy place and the vast majority of the docs wear scrubs. I think it looks better to ask in advance than show up in something 100% inappropriate.

Now shadowing in an office or with a hospitalist...a tie is most likely appropriate.

I shadowed and work in an ED and it is actually required that males wear professional clothes (including ties) with a white lab coat. We have a set of guidelines for shadowing and dress, so I think it would be a good idea to ask the physican to get their feedback just so you follow any guidelines and not have to go home to change.

Have fun- I had a great experience!

 

[pianoman90]

^ ditto on the scrub attire...the last thing you want is an abscess to explode on your nice shirt and tie!

I guess I'm blessed in the fact that my father is an EM physician (MD though), and I got to shadow him and several other MD/DO physicians in the ER. All together, I spent close to a year volunteering in the ER and it was amazing! Since most of the time I shadowed my dad, I knew when I was pestering him too much or when I could assist him - that really allowed me to get the most out of my "ER time."

One thing about the ER you need to know - when it's quiet, it's quiet...and when it rains, it pours! Just be yourself and feel out the situation. If you feel like you're standing around and doing nothing, just ask, "Is there anything I can do to help you out?" Sometimes it may be as simple as getting an elderly patient a blanket, but use that time to develop your patient skills and know that it will make you a better physician in the future.

Best of luck to you!

 

[TexasTriathlete]

I volunteered at, and/or was employeed at the nation's busiest level II trauma center for almost four years, and we all had to wear this:

 

[DrMom]

I shadowed and work in an ED and it is actually required that males wear professional clothes (including ties) with a white lab coat. We have a set of guidelines for shadowing and dress, so I think it would be a good idea to ask the physican to get their feedback just so you follow any guidelines and not have to go home to change.

Have fun- I had a great experience!

So, again, probably the wisest thing to do is ask.

As a sidenote, I personally think it is silly to dress up to work in the ED. I've gotten all kinds of nastiness on me that I wouldn't want on "real" clothes.

 

[brucecanbeatyou]

You've got to give the physician more time than a week to write you a letter.

 

[chudat]

My concern is that if the physician requires more time to write a letter, how will I get the letter? I will be going back to school on the 6th for RA training.
Also, should I even see the letter? Does he need to write a lot of letters since I need one for every school I'm applying to or can I just make copies of the original?

What is interfolio? and is it more legitimate than paper letters?

 

[willis06]

Just be enthusiastic, outgoing and ask a lot of questions.
tell the doc why you are there and what you need... bring a resume with your classes and GPA. I brought all of my essays I had already written for a committee letter which helped.
The doc knows the routine and that letters of rec from a DO are needed.... be upfront with him, don't beat around the bush....

 

[Snake Doctor]

Remember to not discuss about the patient in front of the patient...

 

[painmd87]

I've shadowed ER MDs and DOs over the past year. Really interesting stuff. Emergent care is so vastly different from the urgent and rapid evaluation sections, if your hospital has different sections. Emergent are the gunshot wounds, the shattered legs, while urgent is always "belly pain."

I was told to wear a shirt and tie. The only people who ever say anything are the patients who are under the influence. Most everyone smiles politely when the doctor introduces himself, then "the student."

Definitely take a pen and paper. I would take mental notes, then sit there and write everything down while he filled out notes on the computer. A reporter's notepad works best, because it will disappear into your back pocket. (One patient asked me the other day why I wasn't taking notes during the exam)

Ask EVERYTHING. You will learn so much, and you'll show an interest that the doc can relate for the LOR.

The first DO I shadowed asked my I wanted to see the DO side when I'd already shadowed his MD colleague. I asked him some DO questions, and some about OMM:
Me: "What do you think about OMM? Do you ever use it?"
Him: "A bunch of voodoo. Witchcraft."

You'll really see how many people completely ignore their primary care doctors when you shadow the ER. And you'll also see many lazy PCP who send in their patients to the ER because they didn't feel like doing something themselves....

Enjoy! I hope you're in an inner-city ER, because county/country ones are boring.

 

[beckhunter116]

I would send a thank you note, because everyone likes to be appreciated!

 

[COMedic2Doc]

I was told to wear a shirt and tie. The only people who ever say anything are the patients who are under the influence. Most everyone smiles politely when the doctor introduces himself, then "the student."

In an effort to help with diversity/different areas of the country and different ER levels, I'll go ahead and chime in. First, I've spent a majority of my 8 years in my career in or around ERs from Level Is to Level IVs. To be quite honest, here, you would be treated as a definite outsider and definitely made very uncomfortable by almost everyone in the ER if you showed up in a shirt and tie. You start seeing ties in the Medicine disciplines, but even there it is getting more and more rare. In fact, many residents are generally in scrubs even in the ICUs, ORs, and other areas. Shirt and tie is sometimes, and I do mean sometimes seen in private practice but even there it seems it is going away unless mandated by the particular training program. So, your original idea of a button down shirt and khakis is a good one, as long as you don't care overly much about either one (yes, it is the ER and there is a chance of getting blood, vomit, and other human fluids all over them). Depending on the D.O. that you're shadowing he may help you out and take you to the Physician's changing room and provide you with a set of scrubs (which may or may not be required to be returned). The fact that this physician hasn't given you specific instructions probably means that he expects you to look professional to the level of shirt and pants, quite frankly a tie normally gets in the way in the ED.

Regarding a pen and notepad, it's an idea but be prepared to ditch them at the nurses' or physicians' station. Depending on the day, and the level of ER that you're at it can be quite busy. As you will quickly learn, the ER is a beast to and in of itself. It can take about 5 minutes to go from a dull, lazy morning to hopping all over from trauma to trauma to COR (Code Blue depending on your area of the country) to Abdominal pain to whatever. There are very few generalities for time and pace and you'll need to be there for more than one shift. Also, regarding your questions be sensitive to the workload of the physician, and where he is in his shift, the pace of the ER, etc.

On an LOR, I don't really know what to say. I have seen physicians get upset if you don't provide them with a time to get to know you, what you're all about, etc before asking for an LOR because it is their name that goes on the letter. Others I've seen are extremely generous and try to do their best, but don't expect a great LOR, expect more of a generic LOR. Your timing factor is possibly an issue, depending on what the physician has going on with his schedule, etc. Irregardless of his answer on a letter, definitely send a thank-you note that is personalized because it not only helps you, it will help those coming after you get a chance too.

Other than that, be yourself, relax, be personable and respectful of not only the physician you're shadowing but the nurses, techs, secretaries, etc. and you will find this going a very long way not only now but when you're in residency or on clerkships. Overall, have fun and be prepared to be challenged emotionally, mentally, and possibly physically due to the nature of what is called the Emergency Department. I would love to hear about what you thought of the ER, your experiences, etc. Good luck and remember relax, be yourself, and HAVE FUN! (yes, the ER is meant to be fun while saving lives at the same time!)

 

[edrunner27]

My concern is that if the physician requires more time to write a letter, how will I get the letter? I will be going back to school on the 6th for RA training.
Also, should I even see the letter? Does he need to write a lot of letters since I need one for every school I'm applying to or can I just make copies of the original?

What is interfolio? and is it more legitimate than paper letters?

Some schools provide students with a service where LORs can be sent to a centralized location. From there students can pick and choose which letters go to which schools, etc (I think I ended up with 10 LORs but only used 4). Interfolio is a paid service which I believe acts in the same way. I think LORs still have to be sealed and on official letterhead. They'll make the copies and send them to wherever you designate. The advantages are that 1) you'll know when letters have been submitted to interfolio (I know people who've had problems not knowing if letters were never sent out or just never received when having LORs sent out to schools individually), 2) you give the person writing you the letter of rec the paperwork and envelope and they send it in once they're done writing it so you don't have to worry about getting it before going back to school and you won't be pressing them to get it done in a week. It's been suggested to me that you give people at least a month to write you a letter as a courtesy. It's my understanding that most schools (if not all) will accept letters from interfolio even if they have their own paperwork for LORs.

As for shadowing, be upfront that you're seeking a letter of recommendation. Most DOs are aware that almost all DO programs require a LOR from a DO, if not maybe you can casually mention it. Ask lots of "why" questions (why they're doing this or that, etc) and "what" questions (what are they looking for in this CT or xray, what are typical presentations of ____). Feel out the doctor though because some are more receptive to questions than others but chances are that if the doctor agreed to let you shadow him/her then they'll also be open to questions. Notepad is optional, just remember to ask questions.

I work in an ER and it's kind of a mixed bag when it comes to physicians' attire. Some prefer scrubs, others don't. Ties only seem to get in the way. For shadowing though, I'd say stick with business casual. You probably won't be doing anything too hands on but that depends on the doc you're shadowing. If they want or prefer you to be in scrubs they'll probably be able to get you a set. I've never been thrown up on but I know it happens (chances are you won't either unless you're really lucky ). I've only gotten blood on me a couple times but that was while drawing blood or helping a nurse start an IV. I've gotten some other gross bodily fluids on me during codes but I wouldn't expect you to be in the thick of one. If you're fortunate enough to witness one, find a good place to observe that's not in anyone's way and you'll most likely be safe from any bodily fluids. I really wouldn't worry about getting anything on you, if you do then you can chalk it up to be being a good shadowing experience.

 

[COMedic2Doc]

Some schools provide students with a service where LORs can be sent to a centralized location. From there students can pick and choose which letters go to which schools, etc (I think I ended up with 10 LORs but only used 4). Interfolio is a paid service which I believe acts in the same way. I think LORs still have to be sealed and on official letterhead. They'll make the copies and send them to wherever you designate. The advantages are that 1) you'll know when letters have been submitted to interfolio (I know people who've had problems not knowing if letters were never sent out or just never received when having LORs sent out to schools individually), 2) you give the person writing you the letter of rec the paperwork and envelope and they send it in once they're done writing it so you don't have to worry about getting it before going back to school and you won't be pressing them to get it done in a week. It's been suggested to me that you give people at least a month to write you a letter as a courtesy. It's my understanding that most schools (if not all) will accept letters from interfolio even if they have their own paperwork for LORs.

As for shadowing, be upfront that you're seeking a letter of recommendation. Most DOs are aware that almost all DO programs require a LOR from a DO, if not maybe you can casually mention it. Ask lots of "why" questions (why they're doing this or that, etc) and "what" questions (what are they looking for in this CT or xray, what are typical presentations of ____). Feel out the doctor though because some are more receptive to questions than others but chances are that if the doctor agreed to let you shadow him/her then they'll also be open to questions. Notepad is optional, just remember to ask questions.

I work in an ER and it's kind of a mixed bag when it comes to physicians' attire. Some prefer scrubs, others don't. Ties only seem to get in the way. For shadowing though, I'd say stick with business casual. You probably won't be doing anything too hands on but that depends on the doc you're shadowing. If they want or prefer you to be in scrubs they'll probably be able to get you a set. I've never been thrown up on but I know it happens (chances are you won't either unless you're really lucky ). I've only gotten blood on me a couple times but that was while drawing blood or helping a nurse start an IV. I've gotten some other gross bodily fluids on me during codes but I wouldn't expect you to be in the thick of one. If you're fortunate enough to witness one, find a good place to observe that's not in anyone's way and you'll most likely be safe from any bodily fluids. I really wouldn't worry about getting anything on you, if you do then you can chalk it up to be being a good shadowing experience.

Here, here! Good Code=all kinds of stuff everywhere! Okay, yes this is EM humor coming out, welcome to the Dark Side. I would definitely agree on LORs, try for sealed and mailed to someone else besides you (your health careers comittee if you have one, Interfolio, etc). Find out if your particular school offers a committee letter too, it does help from what I've heard to have the comittee letter and the LORs sent to the schools you apply to. Oh and good trauma=thoracotomy in the ED with your hands doing cardiac massage.

 

[chudat]

Hi Guys,

Thank you very much for all your replies, definitely has lessened my anxiety for this upcoming shadowing. I'm shadowing the EM physician for two days back to back. When should I ask for the LOR? The end of the second day? Also, is it wise to shadow for the entire 8 hour shift? I feel like that's a really long time.

So I should give him my personal statement, CV, and an addressed stamped envelope for the LOR?

Regarding the thank you card, where do I send it to? the hospital or his home. If home, how should I ask him for his address?

 

[tideleonheart]

Just for future reference.. the way I did my LoRs was... I planned for more shadowing than I needed. Then, I chose the doctors that I thought I had the best connection with and asked them. You'll also have one or two who will offer it.

Bottom line: overshoot - you'll get the letters you need.

 

[COMedic2Doc]

Hi Guys,

Thank you very much for all your replies, definitely has lessened my anxiety for this upcoming shadowing. I'm shadowing the EM physician for two days back to back. When should I ask for the LOR? The end of the second day? Also, is it wise to shadow for the entire 8 hour shift? I feel like that's a really long time.

So I should give him my personal statement, CV, and an addressed stamped envelope for the LOR?

Regarding the thank you card, where do I send it to? the hospital or his home. If home, how should I ask him for his address?

When you ask for the LOR is totally your discretion. Personally, I tend to wait for a little while, before asking for LORs, but my experience is also one that is completely different as I am a Paramedic and have spent many years working with my LOR writers. Perhaps someone else can offer an opinion here.

I would definitely give him your CV and an addressed, stamped envelope for the LOR. It just makes things easier in the long run.

On your thank you card, he is probably not going to give you his home address. Therefore, sending it to the hospital attention to him will probably end up getting to him after the department receives the letter.

 

[tdittyx2x3]

More than likely, he will be dressed professionally so you should be as well.

It might be clear by the end of the day that he's writing you the letter, but don't come prepared with the documents. I would offer to drop off the CV and personal statement a few days later. Even better, see if you can set up another day to shadow before you leave. This would be very beneficial. In fact, if you ever had more time on breaks at home to continue shadowing him, it would only make the letter stronger.

You really cannot expect a doc to write a letter in such a short period of time anyway, but you also don't want to give them months - they just won't write it. I'd say ask for it by a specific date with a reasonable deadline. Oh and don't worry about getting the letter before you leave for school. Your school may have a letter handling service, which you'll end up using for apps anyway. If not, then VirtualEvals and Interfolio work as well. You could just have the doc mail the letter directly to them sometime in the coming months.

As for during the shadowing, be conscientious about what's going on around you. There are clear times when you shouldn't be talking and shouldn't be in the way, and others where you are more welcome. Just realize that although you are shadowing, this doc is probably a pretty busy guy with an important job to do. Respect is the name of the game. HAVE FUN

 

[Semicolon]

My experience in an inner-city ER was quite varied. Some days it would be very boring; other days it would be very exciting and hectic. Thing is, I could never get that close to any one doctor because every day I came there would be a different set of doctors and only rarely was I able to shadow one consistently. Overall, I just met one D.O. there, and unfortunately, he was not that exciting nor that receptive to questions.

I met such a large, diverse group of patients (this was an ER in the center of Manhattan). Saw a lot of procedures, but they mostly consisted of draining abscesses (I was surprised how common they were). I was also able to see a few lumbar punctures as well as intubations, which were interesting on its own.

The interns/residents all wore scrubs, but some of the attendings wore shirts and ties (which often made it easy for me to tell who was who). I, myself, was told to wear business casual, and so I did.

I would say that there was one particular moment that has always stood out for me. There was a teenager who overdosed on cocaine and was found wandering the streets; he was still very much under its influence. I asked him if he would like anything and he said "how 'bout a ****'in water?" (you should know that some patients won't be very nice to you, but you should still treat them as you would any other person, nice or not). Anyway, I brought him water, and he responded with "Thank you, Jesus" in the most serious manner (I have somewhat of a beard). I was so amused with him that I offered to accompany him to the CT machine.