Okay, so you actually have some free time in your schedule. Unlike other students you are not going to the lake or going to a party. You decide to use your “free time” to try and get some shadowing experience. Anyone who is a physician has been in that exact situation. I have personally sacrificed many vacations in high school and undergrad to work on getting clinical experience. When it comes to this, students can be nervous about the experience and not know how to go about arranging it or how to interact while shadowing. While every clinic and physician are a bit different, here are a few pearls that I have found along my 10+ year journey to become a physician and surgeon.
While there is not a perfect answer to how much shadowing a student should have, showing a consistent motivation to get into clinics or hospitals looks great on your application. I encourage everyone to shadow both M.D. and D.O. physicians to get a feel for which style fits you the best.
1. Don’t Be Afraid to Ask to Shadow.
If you don’t ask the answer is always no. Every doctor has had to shadow at some point to get into medical school and most are very willing to help a young pre-med. A lot of students get stuck trying to figure out how to approach a physician to arrange a shadowing opportunity. Being a physician is just like any other field of business where networking and meeting other professionals is essential.
When setting up your rotation you can approach this in multiple ways. For a physician you have never met the best way to arrange a rotation is through their office staff. Call their office and talk to one of the receptionists. Introduce yourself and inquire if they allow students to come shadow. You will likely need to talk to the physician’s office manager to get this scheduled.
If you have met a physician personally and they have given you their contact information, don’t be afraid to contact them directly. When they say yes, then follow up with asking the best way to arrange the rotation. Sometimes the physician will fail to respond to you. They likely missed your message and you can always try calling their office.
I would caution about being too pushy for a rotation. If after several attempts with no response from the office, or the physician, it is best to move on and find a different place to shadow. Don’t be discouraged if an office tells you no. There are some practices or physicians that do not allow or want students, there are still plenty of opportunities out there for shadowing.
2. Dress for Success
This seems intuitive, but I have had medical students show up for rotations where they are interviewing for residency spots in less than professional outfits. Like it or not you will be judged by what you wear on your first day. The safest option is to dress business casual for your first impression. No need to bust out your interview suit, but a long-sleeved shirt and tie for gentlemen and professional blouse and pants for ladies should do the trick.
Different docs expect different levels of attire depending on their practice and schedule for the day. This ranges from hospital scrubs and white coat to very formal with a suit and tie. I always found when I was unsure about what to wear business casual was the safest for the first day. I would then adjust my wardrobe to be closer to the physician I am working with. If you are planning on observing in surgery you will be required to change into hospital scrubs. You should come to the hospital in business casual in case there is a change of plans for the day. Hospitals can be very strict about wearing scrubs out of the hospital. You should change into scrubs when you arrive and change back to street clothes when you leave.
3. Introduce yourself to the staff as soon as you walk in the door.
In medicine there are always a lot of new faces that come through clinics and hospitals. I always make it a priority to introduce myself to the staff that I will be working with. I tell them my name, current level of training (undergrad, medical student, resident, ect), who I am working with. For example, when you walk into an office and approach the receptionist state “Hi my name is _ I am an undergraduate from _ here to shadow Dr. _. Can you please show me where I can meet Dr. _.”
If you are in a clinic be friendly and introduce yourself to the medical assistants and nurses. These members of the team will be your best resources to finding your way around the clinic and learning the do’s and don’ts for the doc you are working with.
If you are in the operating room be sure to introduce yourself to the circulating nurse. Ask where you can write down your name so they can record that you were in the room for each individual procedure that day.
The nursing and other staff are a tremendous resource for young students, medical students, and residents. Be kind and friendly to them, they have often worked with the doctor you are with for many years. They can point you in the right direction and look out for you while you are shadowing. They can prevent mistakes before you make them and can answer many of your questions.
4. Know the right and wrong time to ask questions
While the overall goal of shadowing is to learn, you must figure out the best time is to ask questions. As physicians’ we value the education of the next generation of doctors, but patient care comes first. You must remember that there are instances that require a great deal of focus and can literally be life or death situations. There are also times where we put patients in a vulnerable and scared position and the wrong question from a curious student can cause the physician patient relationship to spiral downhill.
When possible try and save your questions for when you are out of earshot of patients. No patient wants to hear you asking what that funny looking bump on their body was or why the physician was particularly interested in a family history of cancer or heart disease. Remember that these are very personal interactions between patients and you must respect the patient at all times.
When observing procedures be careful to read the situation before beginning to ask questions. Like any field there are times when everyone is quiet and focused, this is because at that time they have reached a critical moment in a case or procedure. These situations require very precise steps and timing by all staff. Take advantage and observe and ask questions after the case or the intensity has lifted.
In emergent situations such as a code or where someone is getting intubated, step back and let the team do their job. Each team member from the doctor to the medical assistants have a pre-assigned roles to perform. These can become life and death situations so observe how the team is functioning and be careful to not draw someone’s attention away from the emergency.
5. Come prepared with a few questions and show you are interested in medicine.
Don’t worry, you don’t have to ask some elaborate medical question that is way above your level. Just come prepared to ask some general questions about their job and specialty. The premise to this is to show that you are interested in being there and to gain insight to a career in medicine and that specialty.
Keep a lookout for things that you don’t understand throughout the day so when a doc asks if you have any questions you have some questions ready to go. Don’t be afraid to ask for clarification of something you don’t understand during down time or at the end of the day.
This is a great opportunity to get a glimpse of what their lifestyle is like. Ask them what their call responsibilities are outside of normal clinic or hospital days, what their residency and training was like, and what they like or dislike about their specialty. This is an opportunity for you to begin to find which specialty might fit you the best.
6. Don’t interrupt during the patient interview.
As an undergrad you will have a limited role during patient care. Some physicians may let you go in before them and talk with the patients, but most will have you just tag along. You have to remember that the patient interview is a very developed and pointed skill. While it may seem like small talk, most of the time the physician is using it as a tool to build trust and understand the personality of the patient. Most physicians would prefer that students don’t interject during the interview as this can lead the encounter off course. Unfortunately, these are typically a speak when spoken to situation. Take advantage of observing the unique interaction between different physicians and feel free to ask outside the room about their techniques of interviewing their patients.
7. Understand what HIPPA is and why it is important.
This is something that is VERY important and sometimes misunderstood by shadowing students. Patient interaction and information is protected by Health Insurance Portability and Accountability Act (HIPAA). This means that as someone who is involved in patient care (even as an undergrad student shadowing) patient privacy is protected by law and can have massive fines if a physician or anyone in a physician’s office lets personal patient information become publicly accessible. This can be as minor as dropping a piece of paper in the parking lot or as major as posting about a patient and including identifiable information on social media.
The general rule of thumb is that you should not discuss your patient interactions outside of the clinic. You absolutely should not post ANYTHING that relates to a patient interaction on social media. This is important not only for the physician you are working with but to you as a student applying to medical school. A HIPPA violation could be a major red flag for medical schools in the future. Just be careful to keep your interactions with patients within the walls of the hospital or clinic and you will be fine.
8. When to ask for a letter of recommendation.
Don’t be scared, this is something that every physician has had to do multiple times in their career. This can even be a complement to a physician to be asked for a letter. It is debatable as to when to ask for the letter of recommendation. I have heard people advocate for talking to the physician when they start shadowing and tell them that their goal is to get a letter of recommendation after the shadowing experience. Most students get a feel for how the relationship with the physician has developed and make a judgement call if they would right a strong letter or not and then ask the physician.
Don’t be afraid to ask, but if a doc is making excuses to not write you a letter it is best to try and find someone else as they probably wouldn’t write a strong recommendation. It never hurts to ask multiple letter writers as there is a chance you could have difficulty getting a letter completed despite the best intentions from the docs. Always have a due date for your letter to give a doc and remember to send out a thank you for a letter or recommendation.
9. It is okay to not understand everything that is going on.
One thing to realize is that learning medicine takes a long time and is very complex. As an undergrad you will not be expected to understand the pathophysiology or pharmacology behind the treatments being prescribed. No need to try and cram and study for each shadowing opportunity. With that being said, it is often very hard to explain different treatment algorithms to pre-med students. Don’t be offended if you ask a question and doc doesn’t take time to break down the entire process. It will come in due time.
If at any point when you are shadowing you start to feel queasy or light headed don’t be afraid to excuse yourself from the room and tell someone how you are feeling. If you feel like you are going to faint find the nearest chair or sit down on the ground to prevent injury. This is actually a common situation with people new to the medical field and nothing to be ashamed of. It is not a sign of weakness and we would much rather know you are not doing well than to have you pass out or get sick and injure yourself or the patient.
10. Don’t ask to go home early!
This is an unwritten rule in medicine! A pre-med, medical student, or resident should never ask to go home in the middle of a clinic or O.R. day unless you have made arrangements to leave early before you began the clinic, shift, or case. I know this sounds harsh, but this is something that has been universal in every place I have shadowed, rotated, or worked. Medicine requires endurance and physicians pride themselves for being able to go the extra mile. If a student asks to go home because they are tired or bored, they will likely be told that it is okay that they leave but it will create a negative impression and make the student look disinterested. It is not fair, but it is how the culture is.
If you know that you will be required to leave because of a previous engagement, make sure that is know in advance to you starting your shadowing that day or at the very least the beginning of the day. Most docs are understanding if you have an emergency or an illness that requires you to leave but be transparent about your reasons. The biggest thing is don’t be the student that comes and goes as he/she pleases and make sure you try and stay engaged during your shadowing experience and always be early to the clinic or hospital.
Final thoughts
Shadowing as a pre-medical student gives you invaluable insight into the life of being a physician. This is a tool that will help you decide to dedicate a decade plus of your life and hundreds of thousands of dollars to become a physician. This field has many benefits and many downfalls. A shadowing experience should give you insight into the interaction between the patient and physician and what their day to day life is. Even as an undergrad you will pick up many pearls being in clinics and hospitals. Each little pearl you pick up will be a small piece puzzle that will lead to a successful career as a physician
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