Last Updated on June 27, 2022 by Laura Turner
Updated September 9, 2021. The article was updated to correct minor grammatical errors and to update technical details.
Medical school admissions committees like to see that applicants have spent time becoming familiar with the practical and real side of medicine. Clinical shadowing experiences have become a popular way to assess a desire to practice medicine. However, students may have difficulty finding opportunities to shadow physicians for a variety of reasons including the increasing privacy regulations around protected health information and/or lack of access to physicians to shadow. Luckily there are alternative ways to gain experience around patients and healthcare settings, including paid clinical experiences. Here are five alternatives to clinical shadowing that will provide healthcare exposure, patient contact, and, in some instances, they are paid clinical experiences which can help to fund your future medical education. Since most of these alternatives occur in healthcare settings and may include direct patient contact, they often require a commitment to a training program, certification, and licensure.
Emergency Medical Technician
Becoming an emergency medical technician (EMT) can be a long and labor-intensive process, but can be incredibly rewarding in terms of skills and clinical exposure. Requirements will vary from state to state. In general, you need to be 18 years old, pass an EMT course, and not have a criminal background. There are four recognized levels of training ranging from 58 hours of training as an Emergency Medical Responder to 1200 hours of training to become a Paramedic. Once you’ve completed your training course you will need to take a certifying examination. Depending on your state you may take the National Registry exam or a state-specific exam to become certified (46 states use the NREMT certification which is a private certifying agency). The next step is to obtain and maintain a license through your state agency and find work as an EMT.
The National Collegiate Emergency Medical Services Foundation keeps a current list of college campuses that have their own ambulance service. If you are lucky enough to be on one of those campuses you should be able to find out more information by contacting your ambulance service. If you do not have a college ambulance service you can find your state EMS office. EMTs can be volunteers or may be paid with a salary that can range from $9-$20/hr.
Medical scribes are a relatively new phenomenon that has evolved with the electronic health record and the increased documentation requirements placed on physicians. Scribes serve as a “personal assistant” to the practicing physician by following them during clinical encounters and documenting medical history and exams in the electronic medical record. This is “shadowing” but with a job to get done. Scribes are still primarily based in emergency departments or hospital settings, however, are moving into private practice settings. There is NO direct patient contact for the scribe, however, you will witness many patient-physician encounters, as well as learn documentation skills and requirements. You will also have direct experience with some of the challenges in healthcare administration and practice today. You can read the struggles of one scribe with some of these issues here. You may be asked to keep track of lab results, radiologic findings, and discharge and admission notes.
Training for scribes is variable. The American College of Medical Scribe Specialists is a nonprofit membership association that provides scribe education and certification as a Certified Medical Scribe Specialist (CMSS). Not all scribe companies currently require certification, as many have their own training protocols or on-the-job training. Training typically incorporates how to document a medical history, coding basics, and HIPAA compliance. If you want extra medical terminology training Des Moines University offers a free online medical terminology training course, if you need a certificate the cost is $99.
Certified Nursing Assistant
A certified nursing assistant (CNA) is a direct member of the health care team. Generally, a CNA will work under the direction of a nurse (RN or LPN/LVN). A CNA provides hands-on basic nursing care to patients in a variety of health care settings. CNA’s typically obtain vital signs, weights, and height measurements, and then enter these in the clinical chart. Depending on the setting/specialty they may also assist with basic nursing tasks such as bathing, dressing, eating, and toileting for people who cannot do these tasks alone. Generally, a CNA is required to have a high school diploma or GED. Again, requirements for CNA vary state by state. You will likely take a training course which is usually a minimum of 75 hours and then take a state assessment such as the National Nurse Aide Assessment Program. CNAs work in almost any medical setting and can be in the emergency department, nursing homes, orthopedic offices, operating rooms, or Cardiac cath labs. The best way to find out more about your local options may be to contact a local community college or nursing program or the hospital department in which you hope to work. Salary can range between $12-$18/hr.
Phlebotomists are the technicians that draw blood. They need to know everything about drawing blood, handling needles, tubes, and bags, and other equipment and regulations associated with blood collection. You DO interact with patients and gather information from them. You will develop skills that help you calm patients and explain procedures to them. Depending on the setting, you may be working on your own, or you may be working side by side with physicians, such as in a hospital setting. Phlebotomy training can be a little less structured depending on the setting. Some places will provide on-the-job training, other institutions may require that you take a training course, which can sometimes be found at a local community college or technical school. Courses can range from a 2-year associate degree programs to short certificate courses. The website of the National Phlebotomy Association has 75 accredited hospital and postsecondary programs. Some programs are accredited by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS).
Medical interpreters do not provide direct clinical care. However, they are present during a physician-patient encounter and help facilitate the relationship. Generally speaking, familiarity with a language is not sufficient for being a medical interpreter. You need to be proficient in the language, have an in-depth knowledge of the culture, and have strong interpersonal skills. You must also be familiar with medical terminology in both English and the second language, and be able to maintain an impartial and objective position when interpreting. You can work in a variety of settings including hospitals, nursing homes, surgical centers, and mental health care facilities. The average pay will be dependent on experience and will range between $10-$35/hr.
Again you will likely have to find training and certification depending on where you plan to work. Many programs will require that you work under a mentor, complete an internship, or volunteer for a certain period of time. Bridging the gap for medical interpreters is a 40-hour or 64- hour program run by the Cross-Cultural Health Program. They are based in Seattle, WA, but courses are run by their trainers at various locations throughout the US. You could also become a sign language interpreter. Registry for Interpreters of the Deaf (RID) requires a bachelor’s degree or equivalent experience for certification. As an interpreter of American Sign Language (ASL), they also maintain a searchable directory of educational programs.
Certification may be voluntary or required. You may be able to find out more information about certification through your local hospital or your State health department. The National Board of Certification for Medical Interpreters offers a Certified Medical Interpreter (CMI) credential in six languages: Spanish, Russian, Cantonese, Mandarin, Korean and Vietnamese. The Certification Commission for Healthcare Interpreters (CCHI) offers two levels of certification. ASL interpreters can pursue National Interpreter Certification (NIC) through RID.
These are not the only options for finding paid clinical experiences, as there are other paying opportunities such as becoming a medical transcriptionist, or local and hospital-specific programs such as the Clinical Care extender Internship offered at multiple hospitals in California. I encourage you to look around and find more active ways to participate in your local healthcare system and to be involved in both unpaid and paid clinical experiences.
Deborah Gutman, MD, MPH is a practicing emergency physician and a former assistant residency director. You can find her at www.deborahgutmanmd.com.