Is physician shadowing harmful for patients?

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?

Elizabeth Kitsis is Director of Bioethics Education and Assistant Professor of Medicine, Albert Einstein College of Medicine. She blogs at The Doctor’s Tablet.

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  • Jack

    I’ve shadowed extensively – for the majority of applicants it is wholly unnecessary. The breadth of the medical field allows even those who enter medicine and discover they hate it to find a niche for them.

    Shadowing is only increasing because it’s an unofficial requirement by admissions committees, who grasp any and every arbitrary measure they can to separate candidates from one another. The amount of time spent sitting in the corner of an ER, or following around a doctor representing the entire medical system through a single specialty, shouldn’t be a substantial factor in admissions.

    Address this, and you’ll find the shadowing problem will right itself.

  • Scott Smith

    I have shadowed in various specialties (within the NHS in the UK) and found, on each occasion, that the doctors I shadowed always introduced me appropriately and that I was always given as representative an experience as was possible. Shadowing is also an unofficial entrance requirement of many medical schools in the UK.

    Patients were always asked whether or not they were happy to have me present and, of course, their wishes always respected. Personally, I feel that shadowing was invaluable in helping me to decide that I do truly want to pursue a career in medicine.

  • webhill

    I’m over 40 years old and not a physician, but I did shadow a physician as a high school student. I don’t see what the big deal is, personally. The next generation has to learn. I’m always happy to allow students in the exam room when I’m the patient.

    • Suzi Q 38

      Not for my pelvic exam.

      • webhill

        Too each her own. I think it’s important to provide these learning opportunities. I know I was grateful for my own, 30 years ago. That’s why I have no problem with it now.

        • Suzi Q 38

          I do to, but just for the medical students.
          I would not allow it for a high school or college student.

      • Guest

        Nvm

        • Suzi Q 38

          I don’t mind if it is a male med student.
          I just don’t want a HS or college student to deal with.

  • penguin50

    The term “student doctor” is practically meaningless. If anything, I would think it referred to an intern or resident. It is duplicitous and manipulative for an attending to introduce a high school or college student to a patient as a “student doctor.” I would have difficulty trusting anything a doctor told me if I found out that he or she had told me that a high school or college student was any sort of doctor at all. I would conclude that this is the sort of doctor who will say anything to get the desired response.

    It definitely changes the course of a conversation in subtle and sometimes overt ways to add more people to the mix. Many times, I would not find it too intrusive to include a student observer, but for visits where a sensitive topic must be raised? For times when I expect to receive important news? No; in such cases I would not agree to an observer.

  • Scott

    I shadowed quite a bit as an undergrad, about half surgical, the others
    family practice and pediatric GI. I found that the OR is an environment
    very conducive to shadowing, as the pt is under anesthesia and aside
    from any quick preop conversation, there isn’t really any sensitive
    conversation between doctor and patient. In addition, it allows you to
    openly ask a lot of questions. I thought this was a very enlightening
    opportunity for me, although I know I will not being going into surgery.
    In clinic, patients were asked by the nurse if they would be okay
    having a student present – I feel like if a patient had any sensitive
    information to share, they would be likely to answer no if it would make
    them uncomfortable. I politely stepped out when
    a teenage girl needed to get a stool sample taken, and I could tell she
    appreciated it. However, I worked as a tech at a major teaching
    hospital for 2 years prior to medical school – the specific type of tech
    I was required me to go everywhere in the hospital (OR, ICU, outpt
    clinics, psych, etc). The amount of insight and knowledge I gained from
    this completely overshadowed anything I may have gained from shadowing. So much so, that I feel that REAL clinical experience like this should play a very strong role in the admissions process.
    As a medical student now with a badge and a white coat, nobody seems
    phased one bit by me being around or doing a physical exam – I have
    found that it is all about your ability to create a comfortable
    environment, be respectful/professional, and not be awkward.

    • Mandy

      “I found that the OR is an environment very conducive to shadowing, as the pt is under anesthesia”

      In other words, the hapless patient is unaware of, and unable to object to, strangers who have nothing whatsoever to do with their medical care having a full-on looky-loo whilst they’re unconscious? Oh how convenient for YOU! Too bad for the poor patient whose privacy you’re violating though.

      Next time I have any kind of medical care at all I am going to demand that I receive a signed statement that ONLY those medicos who are actually there to benefit ME are present. No looky-loos, no nosy-parkers, no curious high school kiddies who’ll go back to school and have a laugh with their lunchmates about Mrs. Jone’s flappy labia or what my asshsole looks like, THANK YOU VERY MUCH.

      I don’t think anyone would like the idea that once they’re unconscious, they’re fair game for any number of strangers and kids to mess with and have a good look at, naked and helpless. What the hell, who’s to say they won’t pull their iPhone out and there I’ll be, up on Instagram for the world to see.

      I trust the medical system less and less every day.

      • Scott

        The absurdity of this post is overwhelming, but I’m going to give you the benefit of the doubt – you may have had some bad experiences and shock journalism has given the OR in general a bad reputation. However, your post is condescending and completely lacking intelligence, so allow me to correct you…

        1. The patient has always been informed and consented on having a student present – in fact they have always been welcoming of it in my experience and I have often spoken to them before the case. In fact, when you go to a university medical center, such as the one I was at, it is almost guaranteed that you will have somebody in training in the OR. There is nothing wrong with this and it has been going on since the dawn of surgery – in fact, in the early days, every operating room was packed with onlookers. If you had any misconceptions about this, now you know. There is another Kevin MD article posted yesterday that gets more into this, so read on there if your feathers are still ruffled.

        2. “Next time I have any kind of medical care at all I am going to demand
        that I receive a signed statement that ONLY those medicos who are
        actually there to benefit ME are present.”

        Good for you. Don’t go to a teaching hospital.

        3. “No looky-loos, no nosy-parkers, no curious high school kiddies who’ll go
        back to school and have a laugh with their lunchmates about Mrs. Jone’s
        flappy labia or what my asshsole looks like, THANK YOU VERY MUCH.”

        This is the part where I think you had some experience that messed you up. I don’t know what you think goes on when you are asleep or afterwards, but while you are under anesthesia, nobody is there to try to sexually assult you…in fact, I am very fine not seeing your flappy labia. Two main things: it is actually uncommon for high schoolers to be allowed in an operating room. Second, and most importantly, you are protected under HIPPA, and contrary to your preconceived notions, this protection is taken extremely seriously by doctors, nurses, students, etc. In fact, to shadow anywhere, you always have to do some type of HIPPA training. Back to the asshole thing…You know what your procedure is. If it happens to involve one of those areas and you feel embarrassed having a student around, I would suggest going to a community hospital and specifically stating so. People need to learn, or future labia will never get fixed.

        4. I don’t think anyone would like the idea that once they’re unconscious, they’re fair game for any number of strangers and kids to mess with and have a good look at, naked and helpless.

        First, I just wanted to let you in on something that everyone else is probably aware of: you will probably never ever meet the majority of the OR nursing/scrub team – it has always been this way, so there will be “strangers” present. Either way NOBODY, including anyone shadowing, is going to be anywhere near the sterile field except the two or three people actively involved in the procedure. Also, patients undergoing surgery are draped to expose only the field needed for the procedure. Seriously nobody is going to be there checking you it. We really don’t care. We just want to see the surgery as students, they just want to do the surgery as physicians. That’s it.

        What the hell, who’s to say they won’t pull their iPhone out and there I’ll be, up on Instagram for the world to see.

        5. ” What the hell, who’s to say they won’t pull their iPhone out and there I’ll be, up on Instagram for the world to see.”

        Your first line of defense will be any of the nurses or doctors in the OR that would literally take a student down if he/she tried to pull this off – seriously if anyone tried this that person’s phone would not leave the OR with that picture on it and that person would never see a medical license. We are all HIPPA trained to death and there isn’t damn person who would make it out alive with an Instagram post of a surgery unless the patient was specifically consented for social media display of images of the surgery. Again, we don’t mess around with HIPPA.

        So, I tried to be nice and reasonable. You should be too. You probably don’t trust the medical system because you clearly know nothing about it.

        • EmilyAnon

          Scott, this thread is about lay people who shadow, not
          medical students in training. The objections by patients on this thread (I assume all female) are about non essential observers in exam or operating rooms.

          1 – “The patient has always been informed and consented on having a student present.”

          I had 3 operations at a private hospital with teaching programs. In the 8 page consent form there was a short paragraph with this vague wording (“people in training and others may participate in your care”). That’s it. I presume the “and others” would qualify that shadowing is allowed. There was a crowd during pre-op that followed me into the operating room, but no introductions or explanations who or why they were there. Regarding photography, that also is allowed for “training purposes” with the qualifier that your face won’t be photograped.

          2 – “but while you are under anesthesia, nobody is there to try to sexually assult you. Seriously nobody is going to be therechecking you it. We really don’t care.”

          Now who’s being condescending? The fact that you don’t care is irrelevent. The issue is that WE CARE. And, no, Scott, we don’t feel like we’re going to be gang raped by randy students. Our concern once again is modesty and the ease in exploiting a trusting patient while unconscious for someone else’s agenda. In gyn operations, or the delivery room, the patient is in lithotomy position for the duration with a doctor working between her legs. Most women would be shocked to find out that college students, or non medical lay people are watching. Explicit informed consent obtained? I doubt it.

          4 – “We are all HIPPA trained to death ”

          So you promise not to reveal our names. How does that relieve any patient anxieties expressed here.

          You really seem perplexed or maybe even threatened by the objections of patients and their concerns with privacy. It might be because you’re young and still in the training. Or maybe you just don’t care how the patient feels. But hopefully in the future you will become more receptive to patient sensitivities. Because if you continue with the imperious defense you presented here, don’t be surprised when you see more and more female patients deliberately seeking out female providers with a better chance for empathy.

          • Scott

            I actually care immensely about how patients feel. My responses to that woman’s condescending and ignorant rant was specific to what she said. I would be happy to have a more intellectual conversation about my experiences, which is all I was trying to do in the first place. I don’t agree with uninformed patients being watched during procedures or routine visits, I don’t believe in deceiving patients, I don’t believe in high schoolers taking part in any of this, I don’t believe in patients being uncomfortable, and I respect all of their wishes for privacy. I’m not sure why the two of you feel the need to make unfounded personal attacks, but since that seems to be where this has been taken I’ll just say this…If you are at a teaching institution, it is common sense to make you wishes known, otherwise don’t go there. They will be respected and HIPPA has quite a large umbrella in protecting patient privacy, not just your name. It seems that both of you aren’t very knowledgeable about patient privacy, so I would advise you to read more about it since you feel so strongly. Doctors and students are more respectful than you think, including during prodedures where you are under anesthetic. Between my shadowing and an anesthesia rotation I did, I have been in the OR quite a bit at three different teaching hospitals. I never observed anything even bordering on any of the types of behaviors you two are going on and on about. We are here to help you not to make you feel bad and destroy your privacy. Have a good day.

  • Lois M

    Harmful or not is not the issue. Its a huge invasion of privacy for the patient. I would not want some kid who has nothing to do with my care tagging along with my doctor. It would inhibit me, personally from asking questions. In my opinion, its completely inappropriate for other people, other than necessary health care providers to be around during an examination of a patient. This is my opinion as a patient. I would not want to have to be put in a position to decline some one being around. Why should patients have to go through that? Its not the patient’s responsibility to help young people figure out if they want to be doctors.

    • f. lusu

      my specialist always greats me in the hallway and walks me into the exam room. one time he waited until i was just about to step into the room to say had a med. student and another dr. there to observe. he said, “you don’t mind if they sit in,do you?” ; basically telling me i didn’t mind. i had less than a second to deal with the confusion,discomfort and decision. i had been thinking about what i needed to discuss with the dr., in the short amount of time we had, so i was taken aback by his question. i needed to ask three questions that day and was only able to ask one.he spent most of the time talking to them about the problem,the options and the treatment,while they sat there taking notes. just before the appointment was over he asked me if i had another question. all of them looked at me eagerly. i did have something important, but would never discuss before two strangers,so i never mentioned it. the dr. patient relationship was ruined as soon as i stepped into the room and the search for a new dr. started as soon as i walked out of it.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      Lois ,
      Interesting, but true comment about the invasion of privacy. This is kind of the way I am beginning to feel about the NP student that my regular doctor has been help to teach as she goes through her doctorate program, and she’s not a kid. That I am getting to where I am tempted to ask her to not be in the room because I can’t talk to my doctor about other important things that I may need to talk about at that visit. Not sure yet on whether or not the next time I have to go back to ask that she not be in the room. Will have to think about that a bit more.

    • Mandy

      I agree completely, Lois M.

  • http://twitter.com/JimmyTamHuyPham Jimmy Tam Huy Pham

    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 interaction.

    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.

  • http://warmsocks.wordpress.com/ WarmSocks

    A young man shadowed my daughter’s pediatric rheumatologist during one of her appointments. It was no problem. He sat on the side and observed silently. He was not a high school student, but a college senior who’d been wait-listed by two med schools he hoped to attend. As a routine rheum f/u, it wasn’t particularly personal. If someone was shadowing my doctor during a gyn exam, I’d ask for the person to leave or stand at the head of the table. If I have something confidential to discuss with my doctor, I would not do it in front of a shadow.

  • EmilyAnon

    For the high schoolers who are pondering a medical career, I would direct them to Youtube which has thousands of videos of operations, patient exams, etc. But a curious teenager in my exam room? Never.

    And to find out there are doctors that would use deceptive titles to justify the presence of a lookie loo is so disapointing, and will now make me suspicious of any stranger who enters the exam room with my doctor. Probably at the expense of legitimate medical students and interns, who I have always welcomed.

    • http://twitter.com/HughKee Hugh K Witt-Dubois

      What makes a college student who has been trained in HIPAA and every other hospital/state/federal law and standard any less “legitimate” than a medical student? Cause even being allowed to shadow is a bureaucratic nightmare, and it will never get through unless the student has already done considerable work at the clinic/hospital.

      • EmilyAnon

        I used the word “legitimate” to differentiate between the sham title “student doctor” that some shadowers were allowed to use to deceive patients.

        Let me ask you a question? How does being trained in HIPAA relieve a patient’s embarrassment in having non medical people in the exam room. The patient’s reluctance is probably the fear of disrobing or being examined in front of strangers with intimate details being discussed. She doesn’t care that you took an oath not to post her name or problems on a blog or that you’ve seen a thousand naked bodies so what’s the big deal. Well, it is a big deal for some patients. Maybe even traumatic if a shy patient is coerced into compliance.

        I really appreciate your dilemma with trying to meet requirements to get into medical school. They must be clueless on those boards about patient reluctance to strangers presence during exams. I wish you luck in finding a way out of this, hopefully you will meet liberated patients, and not have to resort to deception to get your training.

  • shiriegale

    I think the issue is not so much the shadowing as the dissembling. If you are a doctor and you have a high school student shadowing, tell the patient exactly what the student is and what they are doing. Choose the cases appropriately. Primary care docs who know their patients well will probably know which people would be open to sharing their doctor visit. I would also point out that if a patient goes to a teaching hospital, they had better be prepared to be part of the teaching process.

  • Molly_Rn

    The patient should be told the truth that this is not a student doctor, but someone interested in going to medical school or something that accurately describes the person. If the patient says no thanks than no shadow. The issue is honesty, privacy and patient choice.

  • Doug Capra

    As one post wrote: “I think the issue is not so much the shadowing as the dissembling.” To often, the “student” is not introduced as a student. Sometimes there may not even be an introduction. A little trick is to say: “Good morning. My name is Dr. so and so and this is Bill or Jane who will be assisting me today.” How about that? And how about this: If it is a high school student under 18 years old — what legal and ethical obligations are there? How about HIPAA? An underage student has no legal liability if he or she doesn’t follow HIPAA requirements. Even if it’s not an intimate exam, the underage student gains access to private, medical information that he or she has no business knowing. Even with patient permission — how is the patient assured that the information will be kept confidential by a high school student who has no legal obligation to do so? Thus, patients should not only be informed that the person is a high school student but also an underage high school student who cannot be held responsible legally for following HIPAA requirements. That’s called full disclosure and true informed consent.

    • Mandy

      Yes, if a real doctor invites someone in to watch, he had BETTER TELL ME if that person has no legal obligation to observe HIPAA privacy laws. Talking about private medical issues in front of some stranger who can thus be putting the whole thing on their iPhone and then go straight out and post everything on Facebook or Tumblr or a blog is NOT ON, I might as well hand my medical records to some skeevy stranger on a public bus!

  • http://twitter.com/Memento1001 Memento

    During my only surgical procedure as a patient, I met with my surgeon to discuss why I was electing to undergo surgery and what I hoped for from the procedure. My surgeon had entered with a clan of about six “student doctors” crammed into the tiny Boston hospital room where I was barely draped in a paper-thin gown. As the young students craned their necks to get better views of my condition, I remember feeling so overwhelmed and self-conscious that I didn’t voice any of the several concerns I had outlined to discuss with my surgeon. I’m ashamed to admit it, but I remained quiet as my surgeon prattled on about what he was going to do.

    Without hesitation I can say that having undergraduate “student doctors” present during a sensitive medical consult can discourage a patient from expressing concerns, asking important questions, or divulging private but pertinent information. Moreover, I can’t recall if my surgeon had asked my permission to have the students present during the consult, but even if he had asked as he and his coterie entered, I’d have been too frightened to say no.

  • http://twitter.com/HughKee Hugh K Witt-Dubois

    Currently an MS1.

    Many attending physicians would themselves not allow me in the room whenever they looked at a patient’s (man or woman’s) private parts.

    When I was shadowing a pediatrician, I was not allowed into the room without explicit informed consent from the patient. Consent could be withdrawn at any time. Once, a boy pointed at me and cried, and I had to leave the room immediately.

    I don’t see the fuss.

  • Ed

    It is absolutely harmful in the absence of true prior informed consent. Its obvious that medical “professionals” (sarcasm intended) do not subscribe to any common basic medical ethics as evidence by this practice and others (pelvic and prostate exams on anesthetized patients by “students”). Patients do have the ethical and legal right to choose who and to what degree a provider (physician, PA, NP, nurse, medical assistant, student, or chaperon) participates in his or her healthcare, even in a teaching hospital. We are after all the patient and customer actually paying for a service. I insist providers participating in my healthcare introduce themselves, cite their professional qualifications, and justify their presence by clearly explaining their role and how I benefit. If unconvinced, I politely but firmly simply say no!

  • http://twitter.com/TheReflexHammer Reflex Hammer

    On ethical grounds I refused to shadow doctors as an undergrad, and I got absolutely shredded during my med school interviews as a result. If an undergrad doesn’t have clinical experience, admissions committees view it as failing to demonstrate seriousness about the field.

    • EmilyAnon

      I’m sorry to hear how the med school treated you. But I’m curious… don’t med schools accept that patients might be uncomfortable with shadowers observing in the exam room? Or is it expected for you or the attending to cajole the shy patient into compliance?

      • http://twitter.com/TheReflexHammer Reflex Hammer

        I don’t feel like med schools want their applicants to cajole patients into letting them observe. They just expect students to have seen some patients while shadowing.

    • http://twitter.com/Memento1001 Memento

      Reflex, I’m both sorry and surprised to read what you’re sharing. I’m encouraged, however, that more and more allopathic medical schools don’t require shadowing for applicants to be competitive. As the director of a West Coast graduate radiology residency program, I sit on our medical school’s admissions committee and can honestly attest that we do not award special considerations to students with even extensive shadowing experiences, though we do see a fair number of these. Beyond competitive GPAs and MCAT scores, far more of a concern to us are the publication/research history of applicants to our MD/PhD program or the well-roundedness (pardon the vagaries of the expression) of applicants to our traditional MD program. I remain doubtful that the shadowing experience, especially one as many here have already attested cloaked in deception (“student doctor” implies the individual is a legal adult, at least a student of a medical college, and professionally aware of and bound by all HIPPA regulations) confers any significant objective, empirical benefit to the pre-professional training regimen.

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    We have medical students regularly in our practice. We inform the patients in advance and ask their permission to have the medical students participate in the visit process. We work with two local universities and public high schools which have pre medical and health programs. If their students are in attendance we announce it in advance and ask the patient’s permission to have the student present for the history , exam and or consultation. If the patient declines we find something else for the student to do while I see the patient. Giving your patients the choice in advance is fair and ethical.

  • traumadoc

    what happened to the use of “virtual medicine”? i am sure it suffices for the beginner.

  • http://twitter.com/HughKee Hugh K Witt-Dubois

    And regarding high school students shadowing, well, you can’t get into a BA/MD program without it. Don’t hate the players, hate the game.

  • Original_Peebles

    From Time Magazine:

    “I was in theatre, the patient was under a spinal
    [anaesthetic] as well and there was a screen up and they just had a
    queue of medical students doing a rectal examination,” a student
    confessed. “[H]e wasn’t consented but because. . .you’re in that
    situation, you don’t have the confidence to say ‘no’ you just do it.” [sic]

    Astonishingly, another student admitted to having “no qualms” about
    giving a female patient an anal examination without her consent because
    they [sic] didn’t consider her permission relevant.

  • http://www.facebook.com/profile.php?id=100000077801405 Jay B. Ham

    Having a pre-med student, or other shadower in the room can create an opportunity for the patient to be the expert. Many patients have brightened as they get to share their knowledge of their condition with someone. Occasionally it strengthens my physician/patient relationship. And sometimes they ask the shadow to leave…literally or by body language.

  • karen3

    My mother became a paraplegic when one of these college student scribes reported a previous CT as normal when it was not. So, think of this. Do you want your kid, who is a junior in college, sued for malpractice?? How awkward will that be when applying to med school….

  • http://twitter.com/patientmodesty Patient Modesty

    As the founder of Medical Patient Modesty, this really concerns me. This is very disturbing and unethical. It is wrong for doctors to deceive patients. This practice should be ended.

  • Ryan

    I have returned to school as an older adult on a pre-med track, and I am very hesitant about the shadowing pre-requisite. For the first time in my thorough examination of the pre-med track Dr. Kitsis has been the first I’ve come across to bring these shared reflections to light. I have been working in health care for a little over ten years now and the idea of shadowing a Doctor in their practice has always felt intrusive to the patient and a breach of privacy. I feel it is completely inappropriate for patients to even be asked if they would permit an unqualified and useless stranger into the room during their exam and/or appointment. Yet medical school admissions committees seem to stress the importance of this practice without regard for the ethical considerations surrounding it. I agree that there are many other ways to learn about what the profession entails without putting patients in a potentially uncomfortable and compromising position. I highly doubt that I will be fulfilling this particular requirement in the pre-med process, but I do fear it may count against me as most other applicants stack their ‘resumes’ with this otherwise questionable requirement, in practice and usefulness. Thank you, Dr. Kitsis, for your work and inquiry into this topic.

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