Volunteer EMT vs. Shadowing

[Lecter]

Which would you say is more valuable? Which would you say med schools prefer? If you had to choose one or the other which would it be? Don't say both- that's a cop out.

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[LizzyM]

With shadowing, you get to see what a career as a physician entails and what a physician is required to do (and the crap s/he puts up with from the insurance companies/gov't, etc). You don't get this perspective as an EMT. Some adcoms like to see that you have an idea of the physician's role in the care of patients: Advantage shadowing.

With shadowing, you aren't really serving others. As a volunteer EMT you are doing something altruistic. Advantage EMT.

As a shadow, you stand quietly and listen and watch. As an EMT you are actively engaged in providing emergency services (or you are sitting around waiting for a call). Schools (and individual adcom members) may value the two experiences differently depending on their biases.


There seem to be differences in personality of those who choose shadowing and those who choose EMT. Sometime one personality type will be more highly valued over another at a given school.

Do whichever you'd make the greater sacrifice for (would you skip dinner for the opportunity? Would you walk 5 miles in bad conditions to do it?).

 

[shindotp]

Great post by LizzyM as usual.

I say do both! Shadowing doesn't take more than part of a summer and a few weeks during the school year. I don't see why you would ever have to do one over the other.

EDIT: didn't see that you said not to say "do both"

 

[Aladdin]

Lizzy's post sums it up.

I once spoke to an dean of admissions at a top 20 school and mentioned that I was shadowing (a lot) and he said that while shadowing is great, don't overdo it. If you do ~50+ hours with a specific specialty, you've probably got a good idea what its about. He said that shadowing is a "passive activity" meaning that you usually aren't involved. If you want to jump from specialty to specialty, that's probably even better because you get to see multiple environments, etc.

On that note, many physicians will let you be a little more involved than just standing around watching. Sometimes they will let you interview patients, consult with you, etc. but that completely depends on the individual doctor.

My opinion for your situation would be shadow for 1-3 hrs/week. Spend most of your time as the vol-EMT. Each month or so, you could switch specialties to broaden your horizons.

 

[aggiedoc2010]

Hi I apply in May 2009. I have been a registered EMT-Basic since fall of 2006. I am currently about to test for my EMT- Intermediate. Since fall of 2006 I have been a volunteer EMT. While there I have volunteered over 1,500 hours. I feel that it is a invaluable experience that you cannot get in pretty much any other position. I have done procedures that some medical students have not even performed (intubation). I have seen the sickest of the sick patients and have dealt with being there when we lose them. While our EMS is quite slow and does not have a large call volume going elsewhere in my case my clincals in inner Houston you quickly get a grasp of the "true" life reality (ie the impoverished conditions, uninsured, and poor care and living conditions provided by family to the sick.)

I recommend to you to get certified and volunteer somewhere where you can get a similar experience and make the most of your hospital/ EMS clinical hours. I have seen far to many smart motivated people make EMS into a career though when they focus too much on volunteer/ working and not enough on school though. I also recommend trying to slip in just a few hours of shadowing if possible.

Good luck in your endeavors.

 

[cpants]

I also recommend more time EMS, less time shadowing. You don't even necessarily have to volunteer as an EMT. You could work for a pay service and make money while gaining experience caring for patients. Shadowing has it's place, but it isn't really necessary. I didn't shadow at all, but I had a lot of EMS experience. Not one interviewer asked me about my lack of shadowing. They did want to talk about interesting calls and learning experiences from my EMS experience.

 

[AdmiralChz]

The OP was banned - does that mean he can't read this response? Always wonder how people get banned around here...

Anyway I agree with the above. I have had great personal success as an EMT as the possibilities of each shift are really pretty diverse. Shadowing is a great way to see the daily routine of doctors, but as one adcom put it, "being on the front lines" really is a whole different ball game. I hope this helps and good luck... even if you're banned!

 

[BlueElmo]

^ I don't know, good question.
good job, shindotp for bringing up a thread almost a year old.

 

[Bartender]

As the Aggie mentioned, college EMS services are a great venue for other experience that adcoms look for: leadership.

I help run my school's EMS and volunteer with a local fire dept as well. Since our service is a department of my school, I get to see the lovely administrative side of providing healthcare. It can get ugly, messy, and dramatic trying to cut through red tape. But the hours I have spent pushing paper and participating in meetings really help connect to the attendings that I shadow at our local trauma center. They know that I know how much coding for insurance sucks away so much time, or how frustrating it is to lead a dysfunctional team while still providing decent healthcare.

If you are really into EMS/EM, but there isn't a service at your campus...found one! NCEMSF has more about this whole avenue of service.

 

[docontheroc]

will open up the entire world of medicine to you at a relatively early stage. if you do it right you can establish long term relationships with physicians (which is ultimately what you want to be) that can lead to mentorship, clinical and basic science research opportunities, rec letters, valuable connections, extremely informative and fulfilling experiences in hospitals and clinics that can extend well beyond the first doc you shadow. all this, while it shouldn't be your primary motivation, will make you a more competitive applicant.

where i come from EMT training is tough, typically entails full time courses during the summer, or 4 to 6 months (or more) of night/weekend classes, usually at a CC. this can be a pain and ultimately you can find a lot more productive things to do with your time. the skills you acquire will pale in comparison to those you develop in medical school, and the payoff is minimal. again, where i come from, premed EMTs are glorified medical transport for the elderly, and while im sure there are rare opportunities for some great experiences and to truly do meaningful work, this is generally not the case since you'll only be on the job for at most 4 years. it also pays, but after you put in a lot of volunteer hours "training".

not knocking emts, i think its great that we have them, just saying, for premed purposes, shadowing is a much more efficient and meaningful use of your time.

 

[shindotp]

^ I don't know, good question.
good job, shindotp for bringing up a thread almost a year old.

Good job for bumping it up more just to tell me what a good job I did.

 

[aggiedoc2010]

will open up the entire world of medicine to you at a relatively early stage. if you do it right you can establish long term relationships with physicians (which is ultimately what you want to be) that can lead to mentorship, clinical and basic science research opportunities, rec letters, valuable connections, extremely informative and fulfilling experiences in hospitals and clinics that can extend well beyond the first doc you shadow. all this, while it shouldn't be your primary motivation, will make you a more competitive applicant.

where i come from EMT training is tough, typically entails full time courses during the summer, or 4 to 6 months (or more) of night/weekend classes, usually at a CC. this can be a pain and ultimately you can find a lot more productive things to do with your time. the skills you acquire will pale in comparison to those you develop in medical school, and the payoff is minimal. again, where i come from, premed EMTs are glorified medical transport for the elderly, and while im sure there are rare opportunities for some great experiences and to truly do meaningful work, this is generally not the case since you'll only be on the job for at most 4 years. it also pays, but after you put in a lot of volunteer hours "training".

not knocking emts, i think its great that we have them, just saying, for premed purposes, shadowing is a much more efficient and meaningful use of your time.

I agree and disagree...
Yes the skills of an EMT (basic) are usually common sense basic first aid type things. If you choose to go higher to paramedic you will be ACLS certified probably before most to all of your med school colleagues and will know many of the cardiac drugs and many others. In addition you get a early exposure to chest decompressions, cardiac rhythm analysis... ect.

The training in my case was an entire summer M-F 8-5 at a community college, but it counted as additional "A" hours . Working as a basic is slightly limited and you mostly end up doing transportation of elderly/ dialysis patients. Depending on where you work though you can occasionally pick up some decent 911 calls. As I said it is all about where you work. I am trying to avoid the transportation service and work part times at an EMS that does 911 for the entire Fort Worth, Texas area.

The training mentioned above can be some of the best experience you get since usually you can ride out with some cool inner city service with lots of trauma and a high call volume.

As for the physician relationships and other great things maybe it is just me but I have yet to experience these benefits especially since most of the oral reports are given directly to the charge nurse, and the physicians are usually busy treating other patients.

 

[docontheroc]

I agree and disagree...
Yes the skills of an EMT (basic) are usually common sense basic first aid type things. If you choose to go higher to paramedic you will be ACLS certified probably before most to all of your med school colleagues and will know many of the cardiac drugs and many others. In addition you get a early exposure to chest decompressions, cardiac rhythm analysis... ect.

The training in my case was an entire summer M-F 8-5 at a community college, but it counted as additional "A" hours . Working as a basic is slightly limited and you mostly end up doing transportation of elderly/ dialysis patients. Depending on where you work though you can occasionally pick up some decent 911 calls. As I said it is all about where you work. I am trying to avoid the transportation service and work part times at an EMS that does 911 for the entire Fort Worth, Texas area.

The training mentioned above can be some of the best experience you get since usually you can ride out with some cool inner city service with lots of trauma and a high call volume.

As for the physician relationships and other great things maybe it is just me but I have yet to experience these benefits especially since most of the reports are given directly to the nursing staff and physicians are completely bypassed in the process.

i definitely agree that if you do decide to go for paramedic, it is a worthwhile experience. however, this commonly a time commitment that most undergrads aren't able to handle (again, where im from, after you become an EMT, another 1-2 years of working before you're eligible to begin paramedic training/classes)

im not really sure what you mean by "the reports are given directly to the nursing staff and physicians are completely bypassed in the process". i suspect you mean the trauma reports. if emergency medicine is something you completely sure about, then by all means EMT away, but, like everyone says during their interviews, there's no way you can pigeonhole yourself into any one specialty as an undergrad. if you haven't explored other specialties (outside of the context of the ER), how can you be sure?

i feel like premeds put too much emphasis on "hands-on" experience. there general desire to play doctor waaay before any of us are rely qualified to do so. this is probably why international medical mission trips are so popular (lower ethics standards in other countries allow for more "hands-on" experience for under qualified undergrads from the US, but this is a whole other thread). if you want to intubate or put in an IV or open up someone's chest why not wait until you fully understand all the physiological aspects of the procedure, and know how to handle (at least in theory) all the sequelae that can result if you screw it up. shadowing may seem "passive". You are observing, but not passively, you should be asking questions about pathology and disease, and experiencing the trials and tribulations of dealing with them through the patient. And at least through shadowing you can do all the things you are capable and qualified to do, like LEARN.

but i cant emphasize enough how much of this hinges on how you go about shadowing. the benefits come only if you do it the right way (again, a whole other thread).

 

[AdmiralChz]

i feel like premeds put too much emphasis on "hands-on" experience. there general desire to play doctor waaay before any of us are rely qualified to do so. this is probably why international medical mission trips are so popular (lower ethics standards in other countries allow for more "hands-on" experience for under qualified undergrads from the US, but this is a whole other thread). if you want to intubate or put in an IV or open up someone's chest why not wait until you fully understand all the physiological aspects of the procedure, and know how to handle (at least in theory) all the sequelae that can result if you screw it up. shadowing may seem "passive". You are observing, but not passively, you should be asking questions about pathology and disease, and experiencing the trials and tribulations of dealing with them through the patient.

So... are you saying that EMTs are unqualified? It takes 1+ years of full-time schooling before you can intubate and even longer to "open up someone's chest" (if you mean chest decompression, open heart surgery is not typically done in the field ). It's not like becoming a life guard or getting a CPR certification - 1 or 2 classes and you can do it. For many, it is their full-time job to do these things. Being able to intubate assumes that you know what to do if things go wrong (laryngospasm, etc)... quick generalizations like this aren't really helpful...

 

[docontheroc]

I have done procedures that some medical students have not even performed (intubation).

this is what i was referring to. and im well aware of the amount of training it takes to do these procedures and that was exactly my point. that people shouldnt glaze over shadowing and sign up for EMT classes just because they feel like there is a higher chance of them doing 'procedures medical students have not even performed'. EMT aren't underqualified in general...but for most of the things i have a feeling many premeds hope they will be able to do as EMTs, they are.

 

[AdmiralChz]

Ack didn't see that quote - sorry! That does change things a bit... it's all about the experience for me, not the fact that I can do this or that (and I know this rings true with most of my friends on the rescue squad as well). Saying that you have done things that "some medical students" have not even done is a little concerning. I will say that the field (pre-hospital) is VERY different and much less structured in general from the hospital setting. For the most part (some exceptions though), things are looser which definitely leaves room for error - the value is knowing when errors occur and acting accordingly.

 

[The Bearded One]

Do BOTH at the same time!!!

I work as an EMT in an ER. I get to do some cool stuff as an EMT, and I get to work with doctors when we are dealing with a patient together. If there are no critical patients, and the ER is not busy, I will just go into patient rooms with him/her and listen and watch how they interact with patients. It's been an awesome experience.

I also get exposure to many different specialties as well, when specialists are called in to see a patient. It's nice because since I am just an EMT, the ER can do without me if necessary, and I am usually volunteered to assist the doctor doing the procedure. I have been in with hand specialists, ENTs, Ortho, pulomonary/cardio, anesthesia, peds and GI (unfortunately).

I do get paid though, so it's technically not volunteer.

This is really a sweet deal if you can do it. Hospitals are interested in hiring EMTs for less than nurses/paramedics, and training them to do some of the things that nurses/paramedics do, in order to save the hospital money. So it's pretty legit.

 

[aggiedoc2010]

To be more clear about my comment and intentions here....

I consider emergency medicine as one of my top interests at the moment, but I realize that it is naive and ignorant to shut out all other specialties without being exposed to and learning more about them.

I do agree that shadowing needs to be emphasized as well, and not in a ER setting. I personally am trying to balance what I have experienced in the field with shadowing experience. I am currently shadowing an allergy and immunology physician, and feel that I learn a great deal about things I have never been exposed to such as childhood asthma and severe food allergies.

As for the "procedures that some medical students have not done" part I don't personally feel any better, more entitled than others, or go around trying to pick up "procedure merit badges". I view my experiences from being able to perform these procedures as extremely beneficial. It has instilled in me an even greater sense of respect for the experience, knowledge and years of practice that physicians in the ER and in general have even for something such as a physical exam that they make look effortless. Additionally, this tiny sliver of knowledge that I have gained has opened an unquenchable love for medicine, the knowledge that I am currently gaining as an undergrad and the future knowledge that gain in the future. I enjoy the endless lifelong learning that we as aspiring physicians undergo.

I hope this does not seem combative, but I wanted to clarify the aforementioned quotes and statements.

To the get back to the OP's topic (if you are still reviewing this thread), I hope that you strongly consider volunteering as an EMT. However please remember that it does not replace the shadowing aspect of learning. Your experiences can tell you a great deal about your drive and determination to be a physician. When you are exhausted and running the third call of the night at 4 am for a college student who is scared because they drank for the first time, and you still treat their condition with the same compassion, respect, professionalism and care that any other patient would be afforded I believe this truly tests your desire.

 

[larpleston]

i definitely agree that if you do decide to go for paramedic, it is a worthwhile experience. however, this commonly a time commitment that most undergrads aren't able to handle (again, where im from, after you become an EMT, another 1-2 years of working before you're eligible to begin paramedic training/classes)

im not really sure what you mean by "the reports are given directly to the nursing staff and physicians are completely bypassed in the process". i suspect you mean the trauma reports. if emergency medicine is something you completely sure about, then by all means EMT away, but, like everyone says during their interviews, there's no way you can pigeonhole yourself into any one specialty as an undergrad. if you haven't explored other specialties (outside of the context of the ER), how can you be sure?

i feel like premeds put too much emphasis on "hands-on" experience. there general desire to play doctor waaay before any of us are rely qualified to do so. this is probably why international medical mission trips are so popular (lower ethics standards in other countries allow for more "hands-on" experience for under qualified undergrads from the US, but this is a whole other thread). if you want to intubate or put in an IV or open up someone's chest why not wait until you fully understand all the physiological aspects of the procedure, and know how to handle (at least in theory) all the sequelae that can result if you screw it up. shadowing may seem "passive". You are observing, but not passively, you should be asking questions about pathology and disease, and experiencing the trials and tribulations of dealing with them through the patient. And at least through shadowing you can do all the things you are capable and qualified to do, like LEARN.

but i cant emphasize enough how much of this hinges on how you go about shadowing. the benefits come only if you do it the right way (again, a whole other thread).

EMTs are medical professionals too, and if they're at a level where they're allowed to do certain procedures, there's nothing wrong with them doing them. Doctors aren't the only people in the world who can intubate, and it certainly isn't "playing doctor" if you choose to become an EMT so that you can do those types of things.

And actually learning about medicine while shadowing? Not every case that the doc you're shadowing is treating is going to be fascinating. I also find it very hard to believe that the few hours that are spent shadowing could even begin to culminate into an experience that allows for you to learn any physiology or pathology; but in terms of seeing what the day to day life of a physician is like, shadowing could be a valuable experience.

 

[docontheroc]

"Studies have questioned the usefulness of endotracheal intubation by relatively inexperienced rescuers because of its deadly complications (1,2). The impressive study from Timmermann et al. (3) reveals similarly catastrophic disasters after intubation in the field, as detected by emergency medical service (EMS) physicians arriving by helicopter and performing laryngoscopy upon arrival at the scene to verify endotracheal tube position."

"A patient does not die from lack of attempted intubation, but because of the failure to ventilate the lungs. This can be caused by undiagnosed esophageal intubation or failure to ventilate with a bag and mask during multiple unsuccessful intubation attempts (5). It is unclear whether the rescuers fully understood the importance of verifying endotracheal intubation or the catastrophic risk of undetected esophageal intubation.

All EMS units carry intubation equipment as part of their standard supplies. However, the tools to verify endotracheal intubation, such as end-tidal carbon dioxide detection devices, are frequently not available. A recent study (6) showed that only 32% of physician-manned ground EMS units in the state of Bavaria in Germany carried end-tidal carbon dioxide detection devices. This lack of technical equipment combined with lack of airway management skills is responsible for the unacceptably high incidence of failure to adequately ventilate the lungs.

One fall-back strategy to endotracheal intubation is bag-valve-mask ventilation. This cannot provide the same level of ventilatory support that endotracheal intubation provides, and risks aspiration, especially during cardiac arrest (7). However, if the tools to verify endotracheal intubation are not available, or if the rescuer is not highly skilled, then it may be better to defer endotracheal intubation to hospital admission. However, tragic complications still occur."

"To reach a 90% success rate with the first intubation attempt, an average laryngoscopist needed at least 57 intubation attempts (8). In one German study, an EMS physician performed an average of nine intubations per year, indicating about one intubation every 1.4 mo. When considering that most cardiac arrest victims are relatively simple to intubate, a given EMS physician or paramedic may be confronted with an extremely difficult airway only once or twice a year (9)."

http://dx.doi.org/10.1213/01.ane.0000255964.86086.63

I may wrong about this, but I don't think intubation in part of the EMT's repertoire of trained and approved techniques, especially without the supervision of a MD. And even so, I don't know how many premed EMTs will have the opportunity to train on 57 patients. At a rate of 10 patients a year, that would take 6 years to be fully competent in the procedure. So, unless a premed is willing to be an EMT for 6 years before applying, he is 'playing doctor' by trying to intubate. But intubation aside, my point was that wanting to do things that are clearly out of your pay scale as a primary motivation for being an EMT is ridiculous. Be an EMT to help people in ways that you are clearly capable of. Then later on, IF you get into medical school and are GIVEN the opportunity to help people in bigger and better ways, then you can start trying to 'play doctor'.

 

[docontheroc]

To address your second point...

I tried to emphasize that shadowing can be an extremely valuable experience, if you do it right, being proactive about shadowing. I wasn't talking about just a "few hours". In the thread, making a comparison to EMT, to do shadowing right is to spend just as much time you would with EMT training shadowing. That's a few hours a day, a few days a week, a few weeks at a time. This is enough time to learn about 'fascinating' and not so 'fascinating' cases (that are still important because they are probably the bread and butter of the specialty), and the physiological and pathological aspects that underlie these cases. Of course, not every doc will be willing to have someone around for so long, but that's part of shadowing the right way, finding physicians that are interested in mentoring and willing to teach. And it wouldn't hurt for you to do a little legwork, writing things you don't understand, and looking them up on your own time. This is what MS3s have to do on service, so might as well get used to it now.

Learning opportunities aside, looking at it pragmatically for your application, with EMT at the end of the day you have a story(s), experience in one field (or multiple within the context of trauma), and a half hearted rec from a ER doc you saw intermittently. If you take the time to form relationships and find mentors through shadowing, you have a story(s), substantive experience in more than one field, strong recs from doctor's that know you on a professional and personal level, and the opportunity to participate in research that can culminate in basic science and clinical abstracts, posters, presentations, and publications. So from a efficiency standpoint (in terms of time spent), shadowing is much more valuable for premeds.

 

[AdmiralChz]

To address your second point...

I tried to emphasize that shadowing can be an extremely valuable experience, if you do it right, being proactive about shadowing. I wasn't talking about just a "few hours". In the thread, making a comparison to EMT, to do shadowing right is to spend just as much time you would with EMT training shadowing. That's a few hours a day, a few days a week, a few weeks at a time. This is enough time to learn about 'fascinating' and not so 'fascinating' cases (that are still important because they are probably the bread and butter of the specialty), and the physiological and pathological aspects that underlie these cases. Of course, not every doc will be willing to have someone around for so long, but that's part of shadowing the right way, finding physicians that are interested in mentoring and willing to teach. And it wouldn't hurt for you to do a little legwork, writing things you don't understand, and looking them up on your own time. This is what MS3s have to do on service, so might as well get used to it now.

Learning opportunities aside, looking at it pragmatically for your application, with EMT at the end of the day you have a story(s), experience in one field (or multiple within the context of trauma), and a half hearted rec from a ER doc you saw intermittently. If you take the time to form relationships and find mentors through shadowing, you have a story(s), substantive experience in more than one field, strong recs from doctor's that know you on a professional and personal level, and the opportunity to participate in research that can culminate in basic science and clinical abstracts, posters, presentations, and publications. So from a efficiency standpoint (in terms of time spent), shadowing is much more valuable for premeds.

Here we go again. "half-heared recs" - since my EMS rec was brought up positively at 7 of my interviews, I would refute this. Typically you aren't getting a rec from the ER doctor as EMS personell - like any other job, you'll look to your supervisor for a LOR. Like anything else, if you have a strong, personal relationship with that individual then you will get a strong LOR.

Plus you can use your ER exposure as an EMT and ask to shadow the ER docs, or you can interact with other specialties (neuro, ortho, trauma, etc...) and get some shadowing experience there. The major limiting factor in a person's EMS experience is their own drive, IMO.

 

[docontheroc]

Here we go again. "half-heared recs" - since my EMS rec was brought up positively at 7 of my interviews, I would refute this. Typically you aren't getting a rec from the ER doctor as EMS personell - like any other job, you'll look to your supervisor for a LOR. Like anything else, if you have a strong, personal relationship with that individual then you will get a strong LOR.

Plus you can use your ER exposure as an EMT and ask to shadow the ER docs, or you can interact with other specialties (neuro, ortho, trauma, etc...) and get some shadowing experience there. The major limiting factor in a person's EMS experience is their own drive, IMO.

no doubt you had a great LOR from you supervisor, but i think generally, it is understood that, all other things equal, a rec from one or multiple physicians is going to be looked upon more favorably then one from you supervisor because ultimate physicians are going to be a better judge of your suitability to enter medical school, and succeed as a physician.

you're talking about using EMT as an outlet for getting shadowing opportunities with other specialties. why not just cut out the middle man. i agree that the limiting factor no matter what you choose is your own drive, but was just trying to make the point that in terms of sheer amount of man hours spent, you would be much better off shadowing.

im so adamant about this because i feel like shadowing is overlooked as a tried, passive experience that you simply do just so you can add it as a bullet on your AMCAS, and say you have experienced the 'day to day' ('what it's like') of being a doc, and it really can be so much more. not just speaking from personal experience, but ive had friends who went at it this way, and after giving them a little bit of advice on how to better approach shadowing they too were able to realize it's full potential. i think people tend to find EMT more rewarding because it is more directed, and not so reliant on your own personal assertiveness, you take a class, you get trained, you work your hours where you know exactly what to do, what is expected of you, and you do your job. with shadowing it's kind of vague what your role is and what you're supposed to do, and there are so many other confounding factors that play into whether or not you get anything out of it, but is largely dependent on you and how assertive you are willing to be.

whatever, in an ideal world you would have time to do both. but since this was put up as a one or the other, my vote still goes to shadowing.