sullen-burger

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What is the purpose of shadowing a nurse as a resident? A medical student?

A morning in their shoes - UCHealth Today


The article above, summarized here, is from this month and it discusses a new activity for residents at a residency program in a community hospital north of Denver, CO. Interns in FM who follow the nurses around for a shift get to see how the RNs do their jobs and then debrief with an interdisciplinary group for the purpose of understanding the hospital's workflow, appreciating the job nurses do, and improving their patient's needs.


My question is pretty basic but these are the nuances that interest me:

Do these experiences change attitudes about the physician-nurse relationship? Could these be applied to other health care workers in an effort to maximize productivity and quality care? Are any medical schools currently implementing these shadowing programs or discussion or as elective courses or are they mostly part of PBL?

And if medical students and/or residents were better informed about what other healthcare providers did, then would patient outcomes improve? Medical errors be reduced? Healthcare costs go down?


Finally, since you could assume that interns will eventually pick up on the workflow and nurse appreciation, Is any of this really necessary since you'll be on the wards anyway, or does the premature preparation make the transition smoother?


*Edit* I've seen a lot of the nurse v. doc threads here so I definitely am not trying to make this question thread into a mud sling. I have a friend in M1 who, as part of her initial coursework, had to meet with PT students, nursing students, PA students, etc as part of a holistic healthcare team-building exercise. Do these work, or are they just a check box for medical education? But then if they don't work then why implement?
 
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mimelim

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What is the purpose of shadowing a nurse as a resident? A medical student?

A morning in their shoes - UCHealth Today


The article above, summarized here, is from this month and it discusses a new activity for residents at a residency program in a community hospital north of Denver, CO. Interns in FM who follow the nurses around for a shift get to see how the RNs do their jobs and then debrief with an interdisciplinary group for the purpose of understanding the hospital's workflow, appreciating the job nurses do, and improving their patient's needs.


My question is pretty basic but these are the nuances that interest me:

Do these experiences change attitudes about the physician-nurse relationship? Could these be applied to other health care workers in an effort to maximize productivity and quality care? Are any medical schools currently implementing these shadowing programs or discussion or as elective courses or are they mostly part of PBL?

And if medical students and/or residents were better informed about what other healthcare providers did, then would patient outcomes improve? Medical errors be reduced? Healthcare costs go down?


Finally, since you could assume that interns will eventually pick up on the workflow and nurse appreciation, Is any of this really necessary since you'll be on the wards anyway, or does the premature preparation make the transition smoother?
*sigh* I can see exactly how this thread is going to go...

Okay, to try to head this off...

One of the biggest problems in medical training is professionalism and working with others in the healthcare system. By far the biggest headache that I deal with as a senior resident are residents, both in my program and outside of my program who have interpersonal problems working in the hospital. The vast majority of cases stem from physician ego and hubris. Take a gander at the allo forum here, you will see it left and right. People will complain about nursing or say, "Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking." It is pervasive among medical students and residents that physicians are the only ones who should be calling any shots and that they and they alone hold the keys to healthcare.

This is an attempt to head that off through understanding and communication. It won't work. It is a good attempt, thoughtful, but, I doubt it won't change anything. You would think (from your post) that people would figure out what other people are doing in the hospital. The reality is, they don't. They have no idea. This is not one sided by any means. Most nurses have little appreciation for what a medical student or resident has gone or is going through. But, it is naive to think that this is not also a medical trainee issue as well. There are common gripes (amount of paperwork, co-workers being lazy, etc), but if you really haven't spent a lot of time seeing and thinking about what others are doing, you aren't going to appreciate it and get anything out of it.

This is like professionalism classes in medical school. Attempt to take on a real problem, but ultimately a problem that is hard to tackle because it is something that you can't always fix. The people that pay attention and figure stuff out during a program like this are highly correlated with the people that would have a problem in the first place or would have figured things out by paying attention as they went along. The people that will have problems down the lines are the same people that will blow this off from the get go and not get anything out of it.
 
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Goro

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You did your due diligence, colleague. That's all you can do. That and maybe smack some fools upside the head.

*sigh* I can see exactly how this thread is going to go...

Okay, to try to head this off...

One of the biggest problems in medical training is professionalism and working with others in the healthcare system. By far the biggest headache that I deal with as a senior resident are residents, both in my program and outside of my program who have interpersonal problems working in the hospital. The vast majority of cases stem from physician ego and hubris. Take a gander at the allo forum here, you will see it left and right. People will complain about nursing or say, "Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking." It is pervasive among medical students and residents that physicians are the only ones who should be calling any shots and that they and they alone hold the keys to healthcare.

This is an attempt to head that off through understanding and communication. It won't work. It is a good attempt, thoughtful, but, I doubt it won't change anything. You would think (from your post) that people would figure out what other people are doing in the hospital. The reality is, they don't. They have no idea. This is not one sided by any means. Most nurses have little appreciation for what a medical student or resident has gone or is going through. But, it is naive to think that this is not also a medical trainee issue as well. There are common gripes (amount of paperwork, co-workers being lazy, etc), but if you really haven't spent a lot of time seeing and thinking about what others are doing, you aren't going to appreciate it and get anything out of it.

This is like professionalism classes in medical school. Attempt to take on a real problem, but ultimately a problem that is hard to tackle because it is something that you can't always fix. The people that pay attention and figure stuff out during a program like this are highly correlated with the people that would have a problem in the first place or would have figured things out by paying attention as they went along. The people that will have problems down the lines are the same people that will blow this off from the get go and not get anything out of it.
 

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*sigh* I can see exactly how this thread is going to go...

Okay, to try to head this off...

One of the biggest problems in medical training is professionalism and working with others in the healthcare system. By far the biggest headache that I deal with as a senior resident are residents, both in my program and outside of my program who have interpersonal problems working in the hospital. The vast majority of cases stem from physician ego and hubris. Take a gander at the allo forum here, you will see it left and right. People will complain about nursing or say, "Stop preaching the big lie about healthcare is a team sport rubbish. Instead promote propaganda which makes students believe again in their profession and the value of their undertaking." It is pervasive among medical students and residents that physicians are the only ones who should be calling any shots and that they and they alone hold the keys to healthcare.

This is an attempt to head that off through understanding and communication. It won't work. It is a good attempt, thoughtful, but, I doubt it won't change anything. You would think (from your post) that people would figure out what other people are doing in the hospital. The reality is, they don't. They have no idea. This is not one sided by any means. Most nurses have little appreciation for what a medical student or resident has gone or is going through. But, it is naive to think that this is not also a medical trainee issue as well. There are common gripes (amount of paperwork, co-workers being lazy, etc), but if you really haven't spent a lot of time seeing and thinking about what others are doing, you aren't going to appreciate it and get anything out of it.

This is like professionalism classes in medical school. Attempt to take on a real problem, but ultimately a problem that is hard to tackle because it is something that you can't always fix. The people that pay attention and figure stuff out during a program like this are highly correlated with the people that would have a problem in the first place or would have figured things out by paying attention as they went along. The people that will have problems down the lines are the same people that will blow this off from the get go and not get anything out of it.
Can you write a book?
 
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sullen-burger

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Thanks @mimelim for your response, that was exactly the answer that I was looking for.


It's hard for me to believe, albeit from my limited experience with and around nurses and residents, that ego and hubris are still such pervasive issues. Maybe in an ER there's not as much downtime to sit and muse about your superiority over xyz since ten patients are waiting on you? I could also be totally naive to the reality.


I found one study done by Dartmouth (I think from 2004?) conducted a 5 year program where they took M1s and M2s to shadow IM and CC nurses, eventually expanding it to peds and others, showed that debriefed students took a lot out of the experience with nurses. Responses sounded like "oh I never realized how much work they do" and "this will influence how I work in the future"


Which sounded hopeful to me!


But I think what you're saying is that people's interpersonal skills rest somewhere on a spectrum, and if they start out unreceptive, then they'll just get through the professionalism class with no retention for the future.


I guess I still live in my rose tinted world but, aren't interpersonal skills filtered for during the interview? But if this dichotomy of people skills exists in residency like you say, then some dingle berries are getting through. And if some are getting sifted through then that means people are good at faking being pleasant with their interviewers, long enough to get in and revert then back to their old dingleberry self?



I guess what I'm saying is that, no amount of classes or shadowing will fix everyone's bad people skills, even in the medical field.

:/
 
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mimelim

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Can you write a book?
I have written countless articles, several chapters, but no book in the works ;) yet... My wife on the other hand is in negotiations with several publishers on her first :)

Thanks @mimelim for your response, that was exactly the answer that I was looking for.


It's hard for me to believe, albeit from my limited experience with and around nurses and residents, that ego and hubris are still such pervasive issues. Maybe in an ER there's not as much downtime to sit and muse about your superiority over xyz since ten patients are waiting on you? I could also be totally naive to the reality.


I found one study done by Dartmouth (I think from 2004?) conducted a 5 year program where they took M1s and M2s to shadow IM and CC nurses, eventually expanding it to peds and others, showed that debriefed students took a lot out of the experience with nurses. Responses sounded like "oh I never realized how much work they do" and "this will influence how I work in the future"


Which sounded hopeful to me!


But I think what you're saying is that people's interpersonal skills rest somewhere on a spectrum, and if they start out unreceptive, then they'll just get through the professionalism class with no retention for the future.


I guess I still live in my rose tinted world but, aren't interpersonal skills filtered for during the interview? But if this dichotomy of people skills exists in residency like you say, then some dingle berries are getting through. And if some are getting sifted through then that means people are good at faking being pleasant with their interviewers, long enough to get in and revert then back to their old dingleberry self?



I guess what I'm saying is that, no amount of classes or shadowing will fix everyone's bad people skills, even in the medical field.

:/
It isn't a problem, until it is. A minority of medical trainees/attendings to be assured, but ever present. I think that it comes out privately earlier in training and then when people feel 'safer' they let it out mid-residency or when they get into practice.

No, we don't select for it. Honestly, I don't think it is about 'faking' it. We aren't talking about people that have obvious communication issues or inability to hold a conversation together. They are perfectly pleasant as long as you see physicians as the clear alphas of medicine with absolutely no peers or need for non-physician oversight or are simply talking about other things, which is what interview day is about.
 

21Rush12

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I wonder whether med students would benefit from more actual clinical experience that's patient care rather than scribing. Being cooperative and aware of nursing staff and their responsibilities seems like second nature, but obviously there is some divide. I wonder whether placing emphasis on demonstrating one's ability to participate in the healthcare team would change this culture?


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What is the purpose of shadowing a nurse as a resident? A medical student?

*Edit* I've seen a lot of the nurse v. doc threads here so I definitely am not trying to make this question thread into a mud sling. I have a friend in M1 who, as part of her initial coursework, had to meet with PT students, nursing students, PA students, etc as part of a holistic healthcare team-building exercise. Do these work, or are they just a check box for medical education? But then if they don't work then why implement?
I've had to do that in my coursework as well. I think they are very well-intentioned, however, I personally don't think they are very effective. I've had two sessions so far and I have absolutely gotten something out of interacting with the nursing students and pharmacy students...except this is mainly due to our natural conversations during the breaks or at the ends of the sessions, NOT the contrived activities they have planned for us. I sincerely think that holding some mandatory health professions mixers/lunches/breakfasts/whatevers where we just go (maybe we are assigned to a table so that they can control the health professions represented) and interact with each other naturally, would be SIGNIFICANTLY better than reading scripts of bad or good interactions. I think getting to know some people in the profession or at least having real conversations with them would do far more for building empathy for people in other professions.

I would imagine they are implemented with good intentions, i.e., let's show them "nurses - they're just like us!" "everyone has an important role", but much like legislation, everyone wants it to be something specific, everyone wants to add to it, until it's a meaningless shell of what it was supposed to be originally. Also because we have to take these surveys at the end to judge the efficacy of the program that are not tailored to allow for feedback or real evaluation of the program.
 

WholeLottaGame7

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It's not a horrible idea if it's for a day or two. It's always helpful to walk a mile in someone else's shoes.

The problem is trying to imagine if the situation was reciprocal, though? What do you think an RN's response would be if you told them their day was going to start by pre-rounding at 0500, followed by rounding, followed by OR (or more rounding), then writing orders, calling consults, talking to families, followed by more rounding in the afternoon/evening, followed by overnight call fielding pages about cross-cover patients you barely know, then rounding again in the morning and writing notes til 10 or 11 the next day? You may or may not get to eat lunch, you use the bathroom sparingly, and what's a break?
 
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sullen-burger

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I've had to do that in my coursework as well. I think they are very well-intentioned, however, I personally don't think they are very effective. I've had two sessions so far and I have absolutely gotten something out of interacting with the nursing students and pharmacy students...except this is mainly due to our natural conversations during the breaks or at the ends of the sessions, NOT the contrived activities they have planned for us. I sincerely think that holding some mandatory health professions mixers/lunches/breakfasts/whatevers where we just go (maybe we are assigned to a table so that they can control the health professions represented) and interact with each other naturally, would be SIGNIFICANTLY better than reading scripts of bad or good interactions. I think getting to know some people in the profession or at least having real conversations with them would do far more for building empathy for people in other professions.

I would imagine they are implemented with good intentions, i.e., let's show them "nurses - they're just like us!" "everyone has an important role", but much like legislation, everyone wants it to be something specific, everyone wants to add to it, until it's a meaningless shell of what it was supposed to be originally. Also because we have to take these surveys at the end to judge the efficacy of the program that are not tailored to allow for feedback or real evaluation of the program.
That sounds like those rehearsed scenarios were at minimum uncomfortable and at worse, highly embarrassing. What did they have you do during the contrived activities, role play when a nurse needs to correct a doctors orders or vice versa?

Nothing beats just talking about each other in an informal setting. Maybe you're right, just send everyone for a small group discussion with snacks.


I have written countless articles, several chapters, but no book in the works ;) yet... My wife on the other hand is in negotiations with several publishers on her first :)

No, we don't select for it. Honestly, I don't think it is about 'faking' it. We aren't talking about people that have obvious communication issues or inability to hold a conversation together. They are perfectly pleasant as long as you see physicians as the clear alphas of medicine with absolutely no peers or need for non-physician oversight or are simply talking about other things, which is what interview day is about.

Congrats to your wife, that's awesome! You though, you gotta step your game up...


Okay yea, that's true about interview days-- Why would ego come up as a red flag during a day full of ego? Of course it wouldn't. Thanks for your insight.


It's not a horrible idea if it's for a day or two. It's always helpful to walk a mile in someone else's shoes.

The problem is trying to imagine if the situation was reciprocal, though? What do you think an RN's response would be if you told them their day was going to start by pre-rounding at 0500, followed by rounding, followed by OR (or more rounding), then writing orders, calling consults, talking to families, followed by more rounding in the afternoon/evening, followed by overnight call fielding pages about cross-cover patients you barely know, then rounding again in the morning and writing notes til 10 or 11 the next day? You may or may not get to eat lunch, you use the bathroom sparingly, and what's a break?

I don't know. Would the RNs be more appreciative of your work load? Maybe. Maybe if everyone saw each other's daily routine then more people would be appreciative of the role everyone plays. What do you think should be the key take away for nurses shadowing a doc?
 

WholeLottaGame7

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I don't know. Would the RNs be more appreciative of your work load? Maybe. Maybe if everyone saw each other's daily routine then more people would be appreciative of the role everyone plays. What do you think should be the key take away for nurses shadowing a doc?
The point is no nursing organization would ever let their nurses shadow a resident through a day like that, so how can they develop an appreciation for what they do?
 
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spartan25

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I've had to do that in my coursework as well. I think they are very well-intentioned, however, I personally don't think they are very effective. I've had two sessions so far and I have absolutely gotten something out of interacting with the nursing students and pharmacy students...except this is mainly due to our natural conversations during the breaks or at the ends of the sessions, NOT the contrived activities they have planned for us. I sincerely think that holding some mandatory health professions mixers/lunches/breakfasts/whatevers where we just go (maybe we are assigned to a table so that they can control the health professions represented) and interact with each other naturally, would be SIGNIFICANTLY better than reading scripts of bad or good interactions. I think getting to know some people in the profession or at least having real conversations with them would do far more for building empathy for people in other professions.

I would imagine they are implemented with good intentions, i.e., let's show them "nurses - they're just like us!" "everyone has an important role", but much like legislation, everyone wants it to be something specific, everyone wants to add to it, until it's a meaningless shell of what it was supposed to be originally. Also because we have to take these surveys at the end to judge the efficacy of the program that are not tailored to allow for feedback or real evaluation of the program.
The big secret about these structured team building activities is that the true purpose IS about the casual conversations we make during the downtime. That's why they give you 30 minutes to discuss a case that only has 10 minutes worth of info in it.
 
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All of this seems to boil down to .
1. Show respect to receive respect.
2.Everyone has a role to play, and listen respectfully even when you dont like the point being brought up or the credentials of the person insisting upon something.

Most of the physicians I have seen dismissed from my hospital have been dismissed due to being disrespectful to other people. Rarely do physicians get called out for erroneous decision making or poor outcomes.
 
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I wonder whether med students would benefit from more actual clinical experience that's patient care rather than scribing. Being cooperative and aware of nursing staff and their responsibilities seems like second nature, but obviously there is some divide. I wonder whether placing emphasis on demonstrating one's ability to participate in the healthcare team would change this culture?


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If you're not participating in the team as a medical student, your school is doing you a major disservice with your clinical rotations.

Except for my 3 weeks on peds surgery where we weren't allowed to do much other than stand at the foot of the table and watch and basically not speak unless spoken to, I functioned as part of the medical team during 3rd and 4th year. On inpatient services, I checked with my patients' nurses every morning to see if there were any updates from overnight. It was also our job to call the nurses on rounds so they could come to bedside and be included in rounds.

I agree, making med students part of the team helped in this regard, but for the most part, you should be doing that in your rotations anyway.
 

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If you're not participating in the team as a medical student, your school is doing you a major disservice with your clinical rotations.

Except for my 3 weeks on peds surgery where we weren't allowed to do much other than stand at the foot of the table and watch and basically not speak unless spoken to, I functioned as part of the medical team during 3rd and 4th year. On inpatient services, I checked with my patients' nurses every morning to see if there were any updates from overnight. It was also our job to call the nurses on rounds so they could come to bedside and be included in rounds.

I agree, making med students part of the team helped in this regard, but for the most part, you should be doing that in your rotations anyway.

I should have worded this better - I meant to say pre-matriculation as a factor in admissions. I don't doubt that you are right on about rotations, my thought was just that some earlier exposure might change students' perceptions when they begin the clinical portion of their medical training.
 

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The point is no nursing organization would ever let their nurses shadow a resident through a day like that, so how can they develop an appreciation for what they do?
The hospital I spent 6 years at was receptive to this kind of thing. The nurses and doctors had great relationships for the most part because everyone understood what everyone else was doing. Obviously this wasn't across the board, but it was good for the most part.
 
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Why do you the think everyone got along? Was there an explicit explanation of the other's role?
 

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Why do you the think everyone got along? Was there an explicit explanation of the other's role?
First of all, it was a community university-affiliated hospital with only one residency (ortho--it has a few more programs now, but most of them came after I left). I've noticed at community hospitals, the staff tends to get along better for whatever reason.

Second, the nursing staff knew how hard the doctors worked. It wasn't a secret that they were running to the floor to do rounds and see consults in between cases, then running to the office. And when our shift was over, the doc was still there operating or waiting to operate at 1530, 1700, or even 1900 sometimes.

But the doctors also knew that even though the nursing staff might not work the same amount of hours or have the same level of responsibility, we were still running around busting our asses to keep things efficient. And they appreciated that. They definitely had a worse relationship with the departments and nurses who were lazy (*cough*sameday*cough*).