Shadowing physicians continues the cycle of paying forward

Is Physician “Shadowing” a Shady Practice? asks Dr. Elisabeth Kitsis in a post at the Doctor’s Tablet, a blog run through the Albert Einstein College of Medicine. She concludes that yes, it is, and invites readers to share their opinions on having high school and college students shadow physicians.

I was reminded of my fantastic 8 week shadowing opportunity as a college student through the Project AHEAD program at the Charles B. Wang Community Health Center in New York City’s Chinatown.

Project AHEAD stood for Asian Health Education and Development. I’m not Asian, but they still accepted me because of my interest in underserved medicine. I’m glad they did. I learned about health care, became aware of race in America, learned what it would take to be an effective member of a health care team, and more.

Three days a week we were primarily based at the clinic, where we focused on our community health project and attended seminars and workshops on health. Two days a week we visited New York Downtown Hospital, where a nurse coordinated our introduction to all the different departments of the hospital. Cafeteria. Nutrition. Signage (how do you direct all patients, regardless of language, to where they need to go in the hospital? What languages do you choose for the signs?). Pastoral care. Dialysis. Outpatient clinic.  We would meet with professionals or shadow in the morning, then give back to the hospital by filing charts in the afternoon. I developed a healthy respect for those who work in medical records.  For all the professionals who keep a health system functioning.

A medical student coordinated our three days each week based at the clinic. Our community project addressed domestic violence — through research and preparing a bilingual pamphlet with information about the cycles of violence, and bilingual shelters for Asian women to go for help.  Leaving a violent marriage was harder if your immigration status was tied to an abusive spouse — we visited an immigration lawyer to learn about the laws that protected undocumented immigrants.  We distributed our pamphlets at a booth set up in the Chinatown health fair at the end of summer, speaking openly about a taboo topic for the culture. The other four summer Project AHEAD participants were fluent in various dialects of Chinese. One had volunteered at the clinic since high school, then went on to graduate medical school, and returned to practice at the clinic.

Project AHEAD was my first service-learning experience, experiential learning at its best — part reading, part shadowing, part doing, part reflection, all learning. On the first day, the medical student gave us a journal, and told us to keep track of our reactions to our experiences. At the end, we summarized what we had learned about ourselves, and health care in America.

I learned I connected easily across cultures, struggled with being tardy, had the ability to see the trees and the forest and express my ideas, needed to encourage others to express themselves when making group decisions, wanted to promote population health, wasn’t sure I wanted to be a doctor — and that I was White.

I learned health care is a team effort, requiring translators, cafeteria workers, lawyers and politicians alongside trained medical professionals — medical assistants, nurses, social workers, psychologists, pastors and doctors alike. And of all the professions I could choose to support health, I made my decision to go to medical school knowing the sacrifices, challenges and benefits of being a doctor.

I could not have learned all I did to prepare for medical school and my future practice serving immigrants in a community health center without Project AHEAD.

I am sad that the health center where I work now does not allow high school and college students to shadow. I know there is a lot to be learned in shadowing, and although the shadowing itself does not immediately directly benefit the doctor or the patient being shadowed, the student can pay it back through completing menial tasks and providing health education, as we did with Project AHEAD.

Or the student can pay it forward by caring for similar populations as a future physician, and allowing themselves in turn to be shadowed by students exploring careers in health care, grooming the next generation of physicians. This cycle of paying forward may one day help us to heal our imminently looming shortage of primary care physicians.

Kohar Jones is a family physician who blogs at Prevention Not Prescription.

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  • C.L.J. Murphy

    Were the patients clearly told, in their own language, “this teenager with us is just a high school kid with no medical training whatsoever, he just wants to observe — would that be all right with you? If not, he’ll leave”?

    Not everyone feels comfortable having sticky-beak teens in on all of their medical care. And it’s really not fair to describe a spotty-faced high school kid, someone not even old enough to legally sign a HIPAA contract, as a “med student” or a “doctor in training”.

  • Michael Rack

    A majority of (but not all) docs in academic/teaching facilities know how to sensitively introduce students to patients- but certainly there is room for improvement and this is something that should be explicitly taught to new faculty members.
    It is becoming increasingly uncommon for private practice docs to let students shadow them.

  • JR

    No, they didn’t ask. It was a pretty terrible office all around. They were the kind who didn’t think much about informed consent in general, they’d take your blood and test it without telling you what the tests were for or even getting your test results. Getting my medical records was pretty eye opening.

    Teaching hospitals do a poor job of care. I don’t mean “quality of medical procedures”. I mean caring for the patient. Making them feel safe. Taking care of their privacy. Checking on how they are feeling. Taking time to talk to explain what a test will involve, how it will feel, what to expect. Explaining the risks or side effects (such as the medicine causing diarrhea).

    If you want to judge the quality of care at a teaching hospital, visit one in tow with a child who has been referred there because they have a mystery diagnosis the local institutions can’t figure out. Watch as the students barge in on consultations to ask when they can get their turn.

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