Shadowing is the sneak peak that lets pre-medical students decide whether they want to see the whole film.
A pre-medical student has very few opportunities to see the practice of medicine before applying to medical school. The pre-medical coursework provides some exposure, but it’s through shadowing that direct knowledge of medicine is gained. Shadowing is therefore a critical experience in the decision to become a physician.
Shadowing is also the opportunity for pre-medical students to earn letters of recommendation. These letters are required for the medical school application and are vital as character references.
Tips for Shadowing
Shadowing plays an important role in both the decision to become a physician and the application process. This is why optimizing the experience is so important. Below is a list of “do’s and dont’s” of shadowing. Actual experiences I have had are in italics to help illustrate the tips.
Be early
If you’re on time, you’re late.
If the shift begins at 7:00 a.m. and ends 7:00 p.m., I plan on arriving at 6:45 a.m. and leaving around 7:15 p.m. It’s considered a professional courtesy to show up a few minutes early (to relieve the person who is going home) and to leave when the work is done, not when the shift is over.
I had one shadow who would come in late, leave early, and spend most of the time staring at the phone. He then asked for a letter of recommendation at the beginning of the second shift.
This demonstrated that he lacked punctuality, courtesy, and dedication.
Show your dedication
The assumption is that the shadow will be present during the time the attending is present. If there are reasons a shadow cannot make it for the entire time, it’s acceptable to ask for permission to come in for only part of the time – but this should be the exception.
If the attending is working 24 hours in a row (like a surgeon may), then find out what hours are best to show up and plan on staying for that duration.
It’s also expected that the shadowing experience will occur several times over a few weeks to months. A one-time shadowing experience isn’t enough to get a sense of what a physician does, nor does it justify asking for a letter of recommendation.
One candidate shadowed me for two months. He came in when I came in, he was there on time and he left when the shift was over. He worked nights and weekends with me.
I had no problem commenting on his commitment and dedication in his letter of recommendation.
On the other end of the spectrum, I had a shadow ask me to rearrange my schedule to suit his shadowing and class schedule. Essentially, he was asking if I could come in on my off days so that he could shadow.
Remember the role of the shadow
It’s called “shadowing” for a reason. The shadow is there to observe and learn. The shadow shouldn’t be providing care, helping people out, or answering patient’s medical questions.
Shadows are not permitted to touch patients in my hospital. They can listen and watch only. One shadow was so eager to be involved that he routinely violated this rule – moving patients, helping nurses and attempting to transport patients. Although I understood what he was doing and why, he had to be corralled several times.
Be professional
Dress professionally, be courteous, polite, and respectful.
Shadows witness the underbelly of medicine: cynicism, signs of burnout, gallows humor and sarcasm. They often want to be perceived as part of the team and join in. This is not advisable.
Medicine’s unspoken culture dictates that one doesn’t enter medicine salty, one earns it. Shadows simply aren’t there. They’re still viewed as outsiders; their undermining comments come off as precocious.
Shadows are better off maintaining humility and a positive attitude.
One shadow I worked with would see patients with me and then come back to my desk and insult them behind closed doors. He would minimize their complaints, accuse them of lying or seeking drugs.
He would go so far as to make underhanded comments at me for taking their complaints seriously, as though I was naive for believing patients. His intention was to appear seasoned, but he actually appeared dangerous and obnoxious.
Wait for downtime to ask questions
Bring a notebook and write down things to ask later. If there doesn’t seem to be time, ask the physician when a good time to ask questions is and respect their answer. This may not happen during the shift.
One shadow asked for dedicated time outside of her shifts with me to just “pick my brain.” I had no problem with this and think it worked out better than trying to squeeze answers into a busy shift. She would write down the answers, read them on her time and then we would later revisit what was discussed.
This demonstrated integrity, curiosity and commitment. It gave me the impression that the questions and answers were important to her; she wasn’t just asking to appear interested or because she was coached to asked questions.
Do your research
Shadows should obtain relevant information prior to arrival.
Arriving with basic information or asking informed questions demonstrates engagement and curiosity. Asking easily discoverable questions demonstrates laziness and lack of preparation.
One shadow wav very curious about what types of insurance our patients had and whether that impacted why they came to the emergency department. This is not easily discovered information. It was clear from what he was asking that he had some knowledge on the topic and was trying to piece it together.
In his letter of recommendation, I spoke about his “systems level thinking” and interest in policy.
A different shadow would ask questions that not only should have been researched beforehand but were obvious, like “Are we in a trauma center?” and “Are you an emergency physician?”
Put your phone down
To the casual observer, researching a question on your phone is indistinguishable from scrolling through Instagram.
By keeping their phones away altogether, shadows can avoid unfortunate misinterpretations of their actions. In turn, they will appear more engaged and alert than they would by repeatedly researching information.
Look at shadowing with a broad lens
Shadows have an opportunity to learn about medical practice as well as the lifestyle of the attending physician.
Shadows must feel out whether it is appropriate to ask the attending questions about their life outside of work; not every attending will want to share these details. After a few shadowing shifts, however, a shadow will generally have enough sense of the attending to determine whether their private life is off-limits for questions.
Interestingly, very few shadows have inquired about this. They ask about things like “burnout” or how the shifts are structured, but don’t ask about things like seeing your family, taking vacations, doing things outside of medicine. I can see where this could be an awkward topic for a shadow to bring up – it might feel like they’re crossing a boundary. However, it would be reasonable to simply ask if this is a topic that could be broached. Many physicians wish they knew more about this before signing up and would be happy to advise about it.
Having a larger lens also means getting insight into the healthcare system as a whole, not just the individual patients.
How does this system work? Where are the barriers to care? How easy is it for a patient to access care, get follow up, have their needs met?
Is this the kind of system you would want to work in? Why or why not?
One shadow was proactive in seeing all parts of the patient care experience – not just my interaction with the patients. He followed the patients as much as he followed me. He watched consultations, followed them to the CT scanner, watched residents do procedures, etc.
It demonstrated that he understood the ‘whole picture’ of patient care and that he was engaged.
Letters of recommendation
What can attending physicians honestly say about a shadower after a few shifts?
They probably won’t be commenting on the shadow’s fund of medical knowledge. The shadow hasn’t been to medical school yet; no one would expect him/her to have a deep understanding of medical content.
The attendings have been through medical school, residency, and are practicing. They have a sense of what it takes, in terms of character, to achieve what they have been through. They have seen people more successful than them in medicine, and they have seen people fail in innumerable ways prior to the point of having a shadow.
Because of their experience, the attendings can comment on the shadower’s likelihood for success in medical school and beyond.
In other words, they can comment on character and personality traits. It is therefore the responsibility and goal of the shadow to demonstrate character through the shadow experience.
Shadowing is the opportunity to demonstrate the character needed as a physician. Medical content is learned in medical school, but the potential to be a great physician can be shown through shadowing.
