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Episode 7. Clinical Shadowing: Benefits and Limitations

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In this episode, Katie and Rebecca welcome guest Patricia Lewis for a discussion of the benefits and limitations of clinical shadowing and the importance of clinical experience for pre-med students.

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Episode 7 Transcript

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Transcript for Hidden Curricula Episode 7

Clinical Shadowing: Benefits and Limitations

Rebecca: Welcome to Hidden Curricula, a podcast exploring aspects of preparation for professional schools that may not be obvious or common knowledge. We will delve into topics of concern for undergraduates and discuss questions that relate to professional school applications. My name is Rebecca Curtin

Katie: and I'm Katie Wang 

Rebecca: We are two of four pre professional advisors at Stanford University. Our group works with students who are interested in professional fields such as law, education, business, and medicine. 

Katie: This podcast is not meant to be advice, like we might give to our students, but rather to shed some light on how an advisor might approach various situations and level the playing field for all applicants. 

Rebecca: Today on Hidden Curricula, we are thrilled that one of our advisor colleagues is joining us. 

Patricia: Let's welcome Patricia Lewis to today's session. Welcome, Patricia.  

Katie: We're so happy that you're here because we're talking about clinical shadowing today. If anyone has thought about clinical shadowing and how to make it accessible to students, it's you. Thanks so much for being here with us. 

Patricia: Oh, happy to be here.  

Rebecca: So let's help our listeners understand first what clinical shadowing is. And then how you came to be the expert you are in the clinical shadowing space. And for those outside the Stanford community, Patricia has been running a shadowing program for undergraduate students for 18 years called SIMS.

Patricia: Yes, thank you. Let's first define shadowing. In this case, students observe physicians and other health practitioners in their environment as they perform their job. They observe interactions between doctors and patients, as well as the hospital or clinical environment. In many cases, they develop a lasting mentorship relationship with these docs, and they have an opportunity to get a better idea of whether this path might be one that they see themselves in. On how this program came about, many years ago, a group of students requested a program where they could be matched with docs, and that is how this program started. SIMS stands for Stanford Immersion in Medicine Series, and it's really a partnership between our advising office and our physician partners at the School of Medicine, and they volunteer to be shadowed. And what it does is it streamlines some of the training and compliance processes that are required for students to be in a clinical space and to shadow physicians who are doing their work in those settings. 

Katie: Wow. Thank you so much, Patricia. So, many innovations and new programs are a result of finding a solution for a problem. Can you share with our listeners what problem or challenge was SIMS able to solve?  

Patricia: Sure, I can think of a few. First, some students don't have easy access to docs. So, in many cases,  they've only had a chance to interact with their family physicians or maybe their pediatricians. So, this offers them another opportunity in a larger clinical setting. Often students discuss cases with their mentors before the patient encounter or sometimes it's after, and it offers them an ample opportunity for them to ask the questions that they have. But the great advantage is also for physicians because, if they sign up to participate in our program, they won't have to worry about any of the hospital clearance process, which can be a big obstacle in many cases. Our program takes care of all of it, students obtain a badge at the end of all their HIPAA training, and they have their clearance, and they can shadow for one quarter, wearing their SIMS badge.  

Katie: Perhaps one more detail that we should share with our listeners who may or may not be familiar with the Stanford campus. And that is that Stanford School of Medicine and many of its hospitals and clinics are in close proximity to the undergraduate campus, really just across the street. So unlike some universities, our students can feasibly get to the shadowing sites during a school day, just like they might for any other class or opportunity. 

Patricia: Yes, yes, that really helps make this program feasible all around. Students can bike or they can walk over to the hospital for their shadowing meetings. 

Rebecca: So students are able to enroll in the SIM shadowing course. They get paired with a physician mentor for shadowing and get access to be present in the clinical space. What might a student be able to do or see once they are there?  

Patricia: Yeah, so one feature of the program is that what a student is able to observe really depends on the physician they're shadowing and what they might be doing on the days when the student is there. For example, some students are able to shadow surgeons in the operating room and observe a surgery or procedure. Some physicians may see patients in an outpatient clinic and a shadowing student might observe an office visit or a series of office visits. Because we have a large group of physicians who serve as our mentors and these physicians may practice primary care or a specialty, there are many aspects of clinical practice that a student may observe in the program. 

Katie: And what's the benefit for students who are able to shadow?  

Patricia: Well, a benefit to the program, aside from seeing medicine in action, is that because students are paired with their physician mentors for a quarter, they may have multiple opportunities to talk with their mentor about various topics on their minds. They can ask questions like, when did you become interested in medicine? And how did you know that this was the field for you? How do you balance your family life with your clinical practice and so on? So I think that that is a great advantage. 

Rebecca: Important information for students to have before they decide to apply to medical school. So we hear from practicing clinicians that medicine is not a solitary endeavor. It's more of a team effort these days. So less country doctor making house calls and more divide and conquer. I imagine that students who are shadowing a physician might actually get to see several different types of health professionals at work. And that sounds super valuable. 

Patricia: Yes, we definitely have had students realize after shadowing that the physician role is 100 percent the one for them. And we've also had students realize that a different role would be better. And either of them is a fantastic conclusion from an experience like this. One element of our shadowing program that our students do is that they spend some time at the end of the experience collecting their reflections on their time in the clinic. And this is really important. It's a critical element of our program since it encourages students to step back and to reflect on what they observed and consider how it has impacted them in their journey. So seldom do we take the time to do that. So I consider this one of the best parts of the program. And actually reading these reflection essays makes us realize the importance of a program like this. 

Katie: So what does a student really do when they're shadowing? Are they able to actively participate in the delivery of healthcare alongside the physician?

Patricia: No, actually no. Shadowing is just that, acting like a physician's shadow, if you will.  They follow the physician and they observe. That's it. As we've already discussed it has some excellent benefits and because of this we know our program is really valuable. In fact, medical school admissions like to see that a student has spent some time shadowing in a clinical setting, because it gives them a better idea of what physicians do in a day, but there's a limit to what happens in a shadowing program. Even more valuable is what we call clinical experience. 

Katie: All right. So clinical exposure versus clinical experience. Those sound very similar. Tell us more about how these are different, Patricia. 

Patricia: Yeah, I many times get this question. Well, shadowing is purely observational. The student is really just watching. Clinical experience is direct patient interaction in a clinical setting.  So this could come in many forms like working as an EMT or a medical assistant, as an interpreter, and you know what, it can even be as simple as escorting patients to the right place, in the hospital or handing out blankets. It can occur anywhere patient care is delivered. So,  hospitals, outpatient clinics, skilled nursing facilities, even patients homes in the case of hospice care. Clinical experience is probably the best way for a student to determine whether medicine is the right path for them because they're right in front of the patient directly interacting with them. Because of this, admissions committees tend to look for robust clinical experience in an  applicant's submitted materials. 

Rebecca: Thanks for walking us through all that Patricia. These are big topics for our pre-med students and I know Katie and I get a lot of questions around this as you do. And we'll definitely touch on them in other episodes. But before we close this episode out, I know our listeners are going to want to know a few more things about shadowing. So first off, for students who don't have this opportunity at their undergraduate institution, or for those who aren't able to participate in a program like SIMS, how can they get the shadowing experience?

Patricia: Well, I can think of a few ways. Shadow a physician they know, for example, or even virtual shadowing if necessary. Students doing research or taking a class from a physician can sometimes shadow these mentors or instructors. Sometimes training for, say, EMT work involves ride-alongs or emergency department shadowing. The reflection part is the one that's quite critical, and it can be done by anyone. We recommend journaling about experiences to our students as a way to reflect and gather their thoughts, both to capture reflections after shadowing and more direct patient experiences. It also provides a reference down the line that they can look back on when they're preparing to submit their applications at the time you think you're going to remember every single detail, but sometimes little things that you write on your observation, start showing you a bigger picture.  

Katie: Patricia, it's been really fun to talk with you today on this forum, one last question for you before you go, and I know this is a tough one. How much clinical shadowing is required for a strong application? How much clinical experience? Is needed to,  

Rebecca: the million dollar question

Patricia: Yeah, so I think it depends. I mean, some programs that require shadowing may indicate a minimum number of hours that they expect to see. So then students should  do some research on  programs of interest.  But like many aspects of the medical school application, it's really evaluated holistically. Schools want to make sure that the applicant knows what they're getting themselves into, what they're applying to do. The way the student reflects upon their experiences in the written application, such as in the work and activities section or in the personal statement, that can often speak louder than numbers of hours alone. So it's not just the numbers, it's really how you have processed and learned from these experiences. But this said, experiences that are sustained and for longer periods of time tend to hold more weight. So, you know, it's hard to imagine that working with patients for the equivalent of a single business day or two in a clinical setting, so like eight to 20 hours or so, could really help a student truly test their interest in a profession.

Rebecca: Thanks so much, Patricia, for sharing your wisdom and experience with us and all those listening. We get to  benefit from it every day, and this hopefully shares the wealth with some other people out there. But I think this topic of shadowing and clinical experience more broadly is on the minds of so many people in the pre-med community, so it's always helpful to learn more about it. And with that, we hope you will continue to join us for future episodes of Hidden Curricula.