Shadowing: The Basics

By Adil Menon

A number of articles have previously addressed the importance of shadowing as a medical student and as a medical school aspirant. Many of these are penned by those already well established in their careers who rightly see shadowing as of paramount importance, but may have overlooked aspects of the actual process. This leaves them presenting the process as an unmitigated good without taking the time to address the practical challenges it entails. It is my hope that as a medical student actively engaged in the process of shadowing and further career exploration I can offer a more accessible and directly applicable perspective.

Purpose and Importance of Shadowing:

Both for premedical and medical students, the central purpose of shadowing is exploration. Having grown up in a medical family, I am very much aware of how striking a distinction exists between living adjacent to medicine and actively engaging with it. For those transitioning from other fields or otherwise entering their premedical education with still less prior exposure to medicine, shadowing offers an essential opportunity to develop comfort with the types of institutions which will serve as our classrooms, workplaces, and in many senses homes for much of the rest of our lives.

The importance of shadowing in large part stems from the fundamental query posed throughout premedical education: whether the rigorous road towards a life in medicine is the one we truly wish to walk. Shadowing is inextricably linked with the ability to answer the vital and ubiquitous question, “Why medicine?” Medicine is an evidence-based profession; consequently, even those who have known since their earliest days that they wanted to be doctors are well served to be able to back this conviction with concrete experience. In the face of the generic responses of “I want to help people” and “I always really loved biology,” the ability to draw upon specific experience gleaned while shadowing will help you stand out. In my case for example, I emphasized what I learned about the ability of doctors to utilize their unique social capital to effect positive change for their patients.

While the ability to distinguish yourself on the interview trail is important, the question of “why medicine” is just as important intrinsically. Hard work, resilience, intellect, and compassion are important across a broad range of fields both within medicine and in the broader society. The direct real world experience shadowing provides enables one to determine whether the role of physician is truly how they wish to serve their fellow man.

While much emphasis focuses on shadowing during the premedical years, shadowing remains important well into medical school. Does one become a physician or a surgeon? Should one focus on clinical care alone or devote significant time to research? How do the needs of a given specialty fit with your life goals and other passions? The ultimate goal of the process is to find joy not only in medicine as a whole, but also in finding that specific aspect of medicine which excites you enough to sustain a career. Shadowing offers an opportunity to transcend the view of medicine presented by medical education. The physician training process naturally emphasizes certain fields, like internal medicine, while offering less time to gain insight into other specialties, like ophthalmology or radiology. There is also an understandable emphasis on academic medicine while offering fewer opportunities within the curriculum to explore other environments like private practice or military medicine. During the premed years and the (relative) freedom of the preclinical years, shadowing offers an opportunity to address these deficits and better construct a vision of one’s career.

How do you find someone to shadow?

As with so much else in the complex medical school preparation and application process, start with your premed advisory office if you have ready access to one. A number of institutions, such as the University of Chicago, have formalized programs through which the office pairs premed students with doctors in the community who have volunteered their time for this very purpose. Not only is this a good opportunity logistically, as the university will make sure you are aware of essential documentation and deadlines, but also guarantees a prospective mentor who is both motivated and vetted by your institution. The logistical convenience of shadowing on one’s own university campus cannot be underestimated.

For those who do not have a shadowing program at their institution or who wish to gain additional shadowing experience when not on campus, a more direct and informal process may be required. A good starting point is to reach out to any physicians with whom you already have a connection. This proximity can stem from factors such as a personal contact as a family friend or physician, as well as past research or classroom experience. Even if these doctors practice a specialty you may not be interested all, experience is invaluable, and you may find your perceptions of the field changed with direct contact. These physicians can also serve as a bridge to colleagues who may serve as future mentors.

The ultimate responsibility of securing the connection falls to the individual. Even if you are paired through your school, it is important for you to personally reach out to the physicians you are shadowing. This demonstrates your enthusiasm and gratitude for the opportunity to work with them. It is possible, depending on the length and quality of the experience, that this initial contact may ultimately yield a recommendation letter that enhances your overall application. As part of this initial contact you should introduce yourself, provide your detailed schedule, clarify any paperwork or further logistics you must tackle, and attempt to set up a first meeting. This interaction also represents the first opportunity to display your professionalism. Use your .edu email whenever possible, and if that option is unavailable make sure the email you are using sounds professional.

What qualities make someone a good person to shadow?

The general principles that apply to a good teacher are in large part equally applicable to a good physician to shadow. The first of these is a willingness to make time for students. Doctors are understandably busy, so a mentor who makes the effort to slow down and bring the students working with them into the dynamics of the team and up to speed is both rare and valuable. Linked to this is an ability to present complicated information at a level appropriate to the learner. Premedical students are smart, but the reason we aspire to go to medical school is because there is so much we have yet to learn. Being able to put aside the jargon and years of accumulated assumed knowledge is therefore something to look for in a physician worth shadowing. A final aspect is taking an interest beyond the strict confines of the shadowing environment. This does not mean becoming best friends with the physician you are shadowing, but remembering that while medicine is a career, it is also the centerpiece around which a physician’s life is built. Taking the time to put their field in the broader context of family, hobbies, and other conflicting priorities can help the student have a better idea of the specialty holistically.

Professionalism while shadowing:

While a student who is shadowing is generally limited in the role they can play in the patient encounter, it is imperative that they remember they are a part of the care team. Clinical experiences take place in a professional environment which has lent its credibility and that of its staff to the learner as an investment in the future of the profession. Paying this investment back demands both professional attire and conduct. For male students this requires wearing dress shirts, dress pants, and a tie, making sure clothes are properly pressed, and being careful about other aspects of appearance such as hair length, jewelry, and tattoos. Female students should follow similar guidelines with the additional caveat that any skirts should be of appropriate length and style and precaution be taken about the height and potential noise of heels. Beyond conveying the appearance of a professional, it is also important to display active engagement by asking questions, taking notes, and approaching the experience with due enthusiasm.

Conclusion:

Shadowing is undoubtedly one of the most important aspects of the medical school application process, both for demonstrating to programs that you are embracing the decision to apply with eyes wide open and for yourself in determining that the life of a physician is one you truly want. Approach every aspect of the process with organization, enthusiasm, and dedication, and it should be a highlight of the process not merely a hoop to jump through.

About the Author

Adil Menon is a second year medical student at Case Western Reserve School of Medicine. Before medical school he received his Master of Bioethics degree from Harvard Medical School. His written work includes Joseph Goldberger: Epidemiology’s Unsung Hero and Is There a United Hippocratic School? in Hektoen International, a book review of The American Healthcare Paradox in HMS Bioethics Journal, and Social Contracts and the Commodification of Life in Foreign Medical Trials in the Rutgers Journal of Bioethics. He has also been acknowledged for editing work on the paper Global Health from a Cancer Care Perspective in Future Oncology and authorship of Geographic Disparities in Reported US Amyloidosis Mortality from 1979 to 2015: Potential Under Detection of Cardiac Amyloidosis in JAMA Cardiology

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