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Is Physician “Shadowing” a Shady Practice?

 Shadows of people in a hospital hallway

I was startled to learn, when interviewing medical school applicants, that tagging along with a physician, or “shadowing,” is a common practice among high school and college students these days. Yes, I did say students as young as high schoolers.

Shadowing provides a way for students to observe at first hand what it is like to be a physician, and helps them decide whether the career will suit them. Medical school admissions committees look for activities such as shadowing as evidence that applicants have been exposed to medical settings, as confirmation both of students’ interest in medicine and of their understanding of the life of a physician.

​But as I spoke with premed after premed about their shadowing experiences, I became uneasy.

As a physician and a bioethicist, I started to wonder whether shadowing—while helpful for students and admissions committees—might potentially be harmful for patients.

The first time my ethical antennae were raised was when an applicant described his experience shadowing a gynecologist. I asked him whether any patients were reticent about having him in the exam room. He said no, but mentioned that he did feel a little awkward that the gynecologist introduced him to patients as a “student doctor,” and then let him watch them undergo pelvic exams. I wondered (to myself) whether these patients would have allowed the student to watch had they known he was a college student trying to decide about his career.

My curiosity about that question led me to examine the issue further. Just how does such a process fit into medicine, and what does it mean for doctors and patients? I examined shadowing in depth along with Michelle Goldsammler, M.D., in our paper “Physician Shadowing: A Review of the Literature and Proposal for Guidelines,” which was published in the January 2013 edition of Academic Medicine. Our goals in the paper were to review the literature to find out whether shadowing is effective, look at the ethical issues connected to it and figure out why people shadow physicians.

What we found troubled me. Of 770 articles in the literature from 1948 to 2011, we could find only 13 that specifically met our criteria for inclusion in the study, and only two of those examined shadowing exclusively. We concluded that more research is warranted and that objective outcomes would be useful. Guidelines on shadowing are needed and a code of conduct needs to be introduced for premed students to enhance consistency in shadowing and ensure that ethical and practical considerations are addressed.

Of course, ​there are other ways to find out what it is like to have a career in medicine. I know this because shadowing was not done in the Paleolithic age when I was in college. My exposure to medicine was primarily through my father, who was an ophthalmologist. I was keenly aware of his dedication to and love of his work, and impressed by the patients who came up to him in restaurants and stores to seize his hand and thank him for restoring their sight. I never witnessed him interacting with patients, though; I never followed him into the exam room. Maybe I was lucky; not everyone has a relative in medicine. To see doctors up close, I worked in the occupational therapy center of a psychiatric hospital, and participated in basic science and clinical research. I also was a candy striper. What’s a “candy striper?” you may ask. It’s a hospital volunteer from another era—but that’s a blog post for another time.

As far as physician shadowing goes, I have misgivings. I wonder whether patients are actually aware that high school or college students are present during their appointments with their physicians. Are the patients given the chance to decline? Even if given this opportunity, does the power imbalance in the physician-patient relationship inhibit them from saying no for fear of irritating their doctors? And if they do allow students into the room, do they share medically important but sensitive information? Might they neglect to mention rectal bleeding because they feel embarrassed at the thought of having a high school or college student present during a rectal exam? Do they omit discussing a concern about having contracted a sexually transmitted disease? Or not answer honestly about their alcohol consumption? Are these concerns outweighed by the benefit derived by premed students from being in the room? I suspect that students would respond in the affirmative.

But I am not sure what patients would say.

Have you ever shadowed a doctor as a premed or high school student? Did you find it useful? As a patient, has shadowing ever made you feel uncomfortable? Share your experiences by leaving a comment. 

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Comments on this entry are closed.

  • K February 14, 2013, 11:16 AM

    Shadowing, in and of itself, I don’t believe is a very effective tool for pre-meds. Today most students see it as a requirement, just another box to check off in a long list of ‘requirements’ for applying to medical school. For students who wish to apply to osteopathic schools, they shadow DO physicians to get the required recommendation letter from an osteopathic physician.

    I was lucky to get paired with an alumni physician of my university through a mentoring program. I believe this was much more beneficial because although I did shadow a few times, we met more often to explore career goals, applying to schools, interview pointers, etc. I believe this sort of mentorship from someone on the inside is more of what we need. Sure this type of mentorship could include shadowing, but if the standard model out there today for pre-meds was to find a mentor, not just a physician to shadow, I think everyone would benefit much more.

  • Mel February 14, 2013, 6:10 PM

    Dr. Kitsis, I wrote a reaction post to this article on my blog but here is a shortened version:

    Today, it is becoming increasingly difficult to get clinical experience because of privacy for patients and the level of comfort that physicians have with students tagging along on their day-to-day activities. It is primarily difficult if you are a student with zero ties to any medical professions (physicians, nurses, therapists, etc). This is understandable because not everyone has parents or relatives as medical professionals and there are numerous ethical dilemmas that arise from shadowing or talking to your relatives about their patients. But for students looking for clinical experience this is not an excuse that can be used when applying to medical school.

    For the students who find work in a medical office or a mentorship program with physicians, this is a way around the “required” clinical experience. I think it is important to understand that clinical experience isn’t something that one has to simply do just to apply to medical school, you need this experience to understand if this is something you could see yourself doing for the rest of your life. I think it is also important to experience shadowing (preferably longer than one day) so that one can write about the experience or discuss it during interviews.

    Honestly, I wouldn’t deter someone from finding clinical experience. Each student’s background and motivation is variable but what they have done to show their interest is what helps a committee understand that student’s ambition and what they are willing to do to learn more about their future goals. People have different ways of getting to medical school and this includes how they obtained clinical experience.

  • Mel February 15, 2013, 1:35 PM

    I have shadowed, but as an older, potential pre-med. I’m in my mid-twenties and deciding if I want to return to medical school. In my experience, I have had worked with great clinicians, who asked patients for permission to have me there. Some patients said no. I was not offended. I think shadowing is very helpful in any career, to see what a day is like. You have this idea of what a day in the doctor’s life is like, but actually shadowing them, and experiencing how much paperwork and how much patient time there is, is hard to replicate. I agree that it could be better incorporated into “mentoring” but I think there should be less focus on how interview and how to apply and be more about working in the medical field then getting in to school.

  • Ryan Gray February 15, 2013, 5:15 PM

    I think shadowing is a valuable tool for the premed student.

    In a day and age of House and Grey’s Anatomy, medicine looks fun. Students need to realize that it’s not all fun and games and that a majority of the time is spent outside of direct patient care. Why try to hide what is waiting behind the doors of the exam room?

    Another reason is what I see as a growing trend in 3 year curriculums in medical school. Students need to be able to get the exposure that they may have received in their 4th year, earlier. They need to be able to pick a speciality with less time to decide and less exposure to the valuable electives that a 4 year curriculum affords them.

    What your discussion should be more focused on is how to educate all involved on the proper way to introduce patients to the fact that an observer will be present if they will allow it.

  • Toby Winter MSRN, FNP February 15, 2013, 7:08 PM

    I think it is fine to shadow a physician but not in any situation where a patient is disrobed. That is totally inappropriate and unnecessary.

  • Ruth Macklin February 18, 2013, 2:49 AM

    Physicians who participate in this shady practice obviously need some ethics education on the topic of shadowing–and introducing students to patients. Referring to a college student as a “student doctor”? Even medical students should be introduced as what they are: medical students, not “student doctors.”

    • Hugh K. Witt-Dubois March 10, 2013, 4:10 PM

      “Student Doctor” is an umbrella term referring to people in all stages of the medical training process: premeds, medical students (like me), residents, and fellows. The term is used in a strictly normative sense.

  • Cait February 24, 2013, 11:45 AM

    When I was 15 and at a pediatrician visit for myself, a 19 month old child was also being seen for a rash. My pediatrician knowing that I wanted to be a doctor, specifically a pediatrician, asked his mother if I , a high school student interested in becoming a pediatrician, could see the rash. The mother agreed. The mother was concerned that her child had chickenpox. The child was wearing a diaper, had copious drooling, and seemed very playful and was covered head to toe with a rash. The rash was what looked like a combination of urticaria and atopic dermatitis. The doctor showed me the way the rash blanched, he then asked the mom what new foods she had given the toddler. She mentioned that he had just had his first strawberries. The doctor explained that the child did not have chicken pox, that this was an allergic rash, and that he should avoid strawberries in the future. He showed me how the hives moved and explained in detail to the other and me what would likely happen. I was very appreciative; the mother relieved that her child would be okay. It was a one time event. From an educational standpoint, I think it was helpful for me. Although I did not enter medical school for another 20 years, I never forgot that interaction. The doctor wanted to encourage me in a field, he asked permission of the parent, I got to interact with the child in a non-threatening way, and I learned two important lessons that day, the doctor asked what mom feared, took a thorough history, allayed the mother’s fears, explained what was happening, taught me about urticaria and I felt empowered because I learned something that day that kept me inspired about the power of medicine.

    As a patient, I have had experiences with medical students and residents who shadow doctors who are rude, disrespectful and who misrepresent their actual station. There is much wrong with the current system of education, ethics being one of them. At my medical school, the ethics instructor had the most questionable ethics of all of our professors.

  • Mandy March 1, 2013, 8:40 PM

    As a post-bacc premed student, I can honestly say that physician shadowing was very beneficial for me. I made the decision to pursue medicine several years after completing my undergrad, and it wasn’t until then that I sought for opportunities to shadow in hospitals and clinics. These experiences confirmed that I wanted to become a physician, furthered my interest in medicine even more, and helped me get an understanding of what doctors do on a daily basis.
    Shadowing, if done properly, can a great benefit, and it should be done over a longer period of time, not just a few days. A “mentoring” approach would definitely be a great thing to see.

  • Riven Homewood March 4, 2013, 3:54 PM

    A medical student was present during my last gyn and opthalmology appointments. A woman at the gyn and a man at the opth. My doctors introduced them to me by name and said they were “first year medical students” (or perhaps second year, but I do remember the year being included.) They were both in their early 20s. There was no pressure on me to accept their presence, but in both cases it was fine with me. For the eye appointment, which included a session of laser surgery, I had no problem at all. I think that one was probably more stressful for my doctor than for me, because the student started offering him advice that was clearly not wanted. For the gyn, since the student was a young woman, I was fine with her being there during my gyn exam. I’m not so sure I’d have been so happy if the observer was a man, but since my gyn doctor is a fantastic person, he would probably have made sure it was somebody his patients would feel comfortable with. My reaction was that any student was very lucky to be able to watch him in action. I don’t think I’d have wanted to have a pelvic exam in front of a high school student. though.

  • Jimmy Tam Huy Pham March 7, 2013, 10:58 AM

    I think shadowing experience is quite beneficial for the students and should be an unwritten ‘requirement’ that medical schools look for in their applicants. I am a medical student. I shadowed in at least 3-4 different environments (surgery, family physician, pathology, and neonatal intensive care) prior to attending medicla school. I observed several invasive procedures at the family practice offices. Most patients consented to having me as an observer; although, there were many occasions where the patient declined to have any observer in the room.

    I have met many colleagues who somehow got away with neither shadowing a physician nor having any healthcare-related experience before medical school. Most of those individuals have stellar grades and high entrance exam (MCAT) scores and, perhaps, were overlooked on their shadowing experience. Through our conversations, many individuals express that they wish they shadowed physicians or had some healthcare experience so they know what specialty they want to go into or that they would feel less awkward during our mandatory OSCE (Objective Structured Clinical Examination), where we are also graded by our physician-patient interactions.

    The bottom line is: exposure to any aspects of medicine (and as much of it as possible) is crucial for an individual who is about to spend the next 8-11 years of their life (subsequent to high school) in a profession where repetitive exposure and practice to procedures and patient interaction are keys to learn.

    Looking from the patient’s perspective, a patient will decline to having an observer if s/he rightly feels uncomfortable to having one. Many patients had declined to having me in their room.

    For a physician to refer to a high school student as ‘student doctor’, in my opinion, is misrepresenting. However, I understand why some physicians would choose to do so rather than introducing the observer as ‘this is a high school student who would like to find out whether s/he wants to pursue a medical career’. I assume those physicians who collectively refer to any observer as ‘student doctor’ do so for the purpose of brevity (cutting down the time and to avoid creating more questionings from the patients). That is my assumption of why a physician refers to any student as ‘student doctor’.

    Lastly, I agree with the authors of the article that a guideline should be in place. The hospitals and offices I shadowed at had a consent form in which the patients signed and agreed to have me as an observer. Even after signing the consent form to have me observe, once I came in the room, the physicians I shadowed furthered introduced me and requested a verbal consent. In my case, a positive written AND verbal consent are clear indications that a patient is willing to have the presence of an observer/shadower in their room.

  • MM March 9, 2013, 3:52 PM

    “For a physician to refer to a high school student as ‘student doctor’, in my opinion, is misrepresenting. However, I understand why some physicians would choose to do so rather than introducing the observer as ‘this is a high school student who would like to find out whether s/he wants to pursue a medical career’.”

    It shocks me that so many doctors are okay with lying to their vulnerable and trusting patients.

    Now that I know that doctors apparently consider it “fair game” to lie to me and tell me that a kid with absolutely no medical background or training whatsoever (and no HIPAA obligations either!) is a “student doctor” in order to scam me into having my privacy violated, I will be *extra* careful from here on in.

    Would you lying doctors scam your mother or your wife or your daughter into striping naked to be perused by a “medically curious” high school science class? Well how is it any better to do that to other people then?!

    UGH, this just makes me shudder.

  • Jim March 10, 2013, 1:27 PM

    As a former medical rep selling antibiotics and other specialty drugs in hospitals, I was able to round with many physicians in the various units. I watched people die, it allowed me to better advise physicians about using my drugs and it gave me a deep appreciation of what a physicians life was like.
    I believe that to allow high school students to shadow physicians in any situation in wrong in many obvious respects. I would say at minimum a college student should be able to show they have applied to a PA or MD/DO program in order to be allowed to shadow physicians.

  • Adrianne April 21, 2013, 1:44 AM

    As a non-traditional premed student, I had the incredible fortune to do a summer internship at a family medicine residency program, in which I shadowed physicians across many departments for 8 weeks. The doctors I shadowed asked their patients for permission to have me observe, and there were a couple of patients who declined–perfectly understandably. Perhaps because it was a teaching hospital, most patients agreed, and I’m extremely grateful they allowed me the opportunity to confirm that this arduous path is the right one for me. Shadowing needs to be carefully managed to protect patient rights, but at the same time, it provides students an invaluable exposure before they make the commitment to a demanding life. I shudder to think how many doctors went to medical school without this understanding, and despite finding it to be a poor fit, continued because they had already invested too much.

  • Doctor Shadow May 15, 2013, 2:46 PM

    I believe there are several reasons to shadow a physician. Shadowing opportunities provide aspiring medical students with unique insights in the life of a physician. Furthermore, most medical schools encourage or require premeds to have at least one shadowing experience prior to matriculation.

    Unfortunately, it doesn’t always give true insight to a life of medicine. Many cannot possibly foresee the years of hard work spent as a resident or intern, the weeks without sleep and being on call, etc.

  • noneya May 24, 2013, 5:01 PM

    I did an I walked away from it a bit bewildered.
    They doctor I shadowed was very arrogant and used his position as a doctor on medical admissions comittee as a sense of power to intimidate me.
    I look back an wish I had never shadowed.
    Because it made me doubt myself as a student and as a potential medical doctor.
    My advise is students keep your nose in your books and out of the hospitals and clinics.
    Its a doggy dog world out there.

  • Kevin July 5, 2013, 8:59 AM

    Having shadowed nearly 200 hours with dentists from different specialties (I know this is a forum for pre-med shadowing, but the ethical concerns are similar even if a patient might be less embarrassed to share his/her oral health concerns), I can say from personal experience that I have found shadowing to be invaluable in terms of motivating me toward a career in dentistry and helping me decide which specialty is most suited to my interests. Experiences I have had interacting with patients, who were made well aware that I was a pre-dental student in college, have given me insight into the kind of impact a dentist can have on a person’s life by restoring good oral health and restoring his/her smile– perhaps most resonating was an opportunity I had to observe an in-hospital mandibular osteotomy. Had I not had these experiences, even though I have been interested in dentistry since middle school, I would not have the same inspiration and passion about entering the field as I do now. That said, I think shadowing can be done in an ethical manner so long as the practitioner provides appropriate introductions and obtains the patient’s consent (I have only had one patient not want me to observe), and I think shadowing in general is extremely beneficial– to the right people. Students who shadow just to earn hours are wasting a valuable opportunity to gain deep insight.

  • Kevin Wang October 23, 2013, 1:47 AM

    I’m a high schooler and despite literally calling every doctor in the Harris Methodist physician catalog, I managed to get exactly one doctor to agree to shadow. I keep getting people answering the phones telling me shadowing is somehow illegal due to HIPPA regulations. Could somebody clear that up for me? And I’ve been turned down literally dozens of times before I even ever get to talk to doctors. I did get to shadow two podiatrists and a cardiologist for a grand total of 16 hours. None of them were willing to have me shadow them long-term, and one of the podiatrists during a shadowing visit even started questioning why I was shadowing him at all, and told him I was disrupting his routine and that shadowing was way beyond high schoolers. I may have just had a negative experience, but I don’t believe shadowing was really that useful.