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The DO | In Training | Training Ground

Art of shadowing: Students need to be committed, curious, professional

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Observing physicians in practice gives premedical students a sense of the rigors and rewards of medicine—the day-to-day realities of caring for patient after patient, administering medical records, consulting with other health professionals and managing support staff. By shadowing osteopathic physicians in particular, students can develop an understanding of osteopathic principles and practice to make informed decisions about whether to become DOs. In turn, by welcoming premeds into their practices, DOs help ensure that those who apply to osteopathic medical school truly want to be there.

Dr. Pham

Family physician John T. Pham, DO, leads monthly meetings for premedical students at the office of the Osteopathic Physicians and Surgeons of Oregon in Portland. While in solo practice, he would invite the most committed, enthusiastic students to shadow him for a year or more. (Photo courtesy of Dr. Pham)

Premeds who would like to shadow DOs should display the character traits of top-notch medical students and physicians, including dedication, commitment and professionalism, and show genuine curiosity about the DO difference, says Oregon family physician John T. Pham, DO, who has mentored hundreds of undergraduate college students considering medical careers. Other DOs, as well as students, stress the importance of establishing ongoing relationships with osteopathic physicians and securing shadowing experiences in a variety of specialties and practice settings.

Although shadowing an osteopathic physician may be a prerequisite for obtaining a letter of recommendation from that DO, snagging such endorsements should not be the main purpose of observing practicing physicians, says Dr. Pham, who has been leading monthly events for premed students for a dozen years. These meetings, which take place at the office of the Osteopathic Physicians and Surgeons of Oregon in Portland, not only expose students to OPP, networking opportunities and the demands of medical school and medical practice, but also let Dr. Pham and his DO guest speakers gauge the interest, enthusiasm and demeanor of the students who attend.

“Students had to attend at least three of the events before I would invite them to shadow me,” says Dr. Pham, who ran a solo family medicine practice in Portland for nine years before joining the faculty of WesternU/COMP-Northwest, the Lebanon, Ore., additional location of the Western University of Health Sciences College of Osteopathic Medicine of the Pacific in Pomona, Calif. Many of the premeds shadowed Dr. Pham for more than a year. Only those who impressed him with their commitment to osteopathic medicine received letters of recommendation.

Glendale, Ariz., family physician Shannon C. Scott, DO, decided to apply to osteopathic medical school after shadowing an osteopathic family physician in Washington state for a year and a half, driving about an hour each way to the practice, three times a month. “Shadowing should not be a one-time event,” says Dr. Scott, the new physician in practice representative to the AOA Board of Trustees. “You need to spend repetitive time with a physician. In primary care practices, you learn more when you have the opportunity to see patients longitudinally.”

Besides building relationships with osteopathic physicians and sometimes their patients, students who shadow physicians over an extended period may have the chance to develop some basic medical skills, notes Dr. Pham, the AOA’s 2007 Mentor of the Year. Depending on their interest and ability, Dr. Pham allowed premed students to take blood pressure readings and patient histories and prepare patients for osteopathic manipulative treatment.

“I took more than 50 blood pressure readings and other vital signs during the year I shadowed Dr. Pham as a premed student,” recalls Filza Akhtar, DO, a second-year family medicine resident at Oregon Health & Science University in Portland. “Because of this experience, I felt like I was ahead when I started med school.”

Thomas Grawey, OMS III, also recommends shadowing individual physicians multiple times. “The more you can work with a physician, the more likely it will be that he or she will write you an original, detailed letter of recommendation,” says Grawey, a student at the Midwestern University/Chicago College of Osteopathic Medicine in Downers Grove, Ill.

As a premed, Grawey was already interested in emergency medicine, so he trained as an emergency medical technician to gain some exposure to the field. His EMT training served him well when he shadowed emergency physicians and primary care physicians. “I was allowed to put in EKG leads and take vital signs,” he says.

Chase K. Nelson, OMS II, urges premeds who are unsure of their career goals to seek out diverse shadowing options, from the operating room to the family physician’s office, to glimpse the breadth of medical specialties. “If you see physicians in a variety of specialties, you’ll have a better idea of what you want to do,” says Nelson, his class’s incoming president at WesternU/COMP-Northwest.

Whom to shadow

Those who are considering osteopathic medical school should shadow both DOs and MDs to get a sense of the differences and similarities, advises Grawey, the director of the undergraduate division of the Student Osteopathic Medical Association (SOMA), which is known as Pre-SOMA.

Soon to begin her first year at the Michigan State University College of Osteopathic Medicine (MSUCOM) in East Lansing, Maria Swetech encourages students who might be interested in osteopathic medicine to get involved in the Pre-SOMA chapter at their school and, if one doesn’t, exist, to start one. MSUCOM’s Pre-SOMA club invites practicing DOs from around East Lansing to speak at student events, says Swetech, who led the chapter before graduating this month. Because these physicians have already shown interest in helping premeds, they are promising candidates for shadowing, she notes.

Pre-SOMA members are invited to attend SOMA’s national conferences and DO Day on Capitol Hill, events that offer valuable networking opportunities with DOs as well as osteopathic medical students.

The daughter of a DO, Swetech spent countless hours in her father’s office while growing up and knew many of his colleagues. While most premeds don’t have such close ties to the profession, they should not be shy about speaking with friends, classmates, neighbors and teachers to see if someone they know is close to a DO, she suggests.

Grawey often directs premeds to the AOA’s iLEARN Mentor Program, which lets student log in to find DOs in their geographic area who have expressed interest in mentoring.

While most osteopathic medical societies do not have premed programs as elaborate and structured as Dr. Pham’s at the Oregon association, state osteopathic medical associations and state chapters of osteopathic specialty societies may be able to suggest DOs who are willing to be shadowed.

In addition, college premed advisers may have the names of DOs, as well as MDs, who have expressed willingness to be contacted by students.

For shadowing leads, premeds can also investigate summer internship programs for students considering medical careers.

Besides DOs, Dr. Pham recommends that premeds shadow osteopathic medical students in the classroom and OPP lab to get a sense of what osteopathic medical school will be like. He is developing a student shadowing program for premeds at WesternU/COMP-Northwest, where he serves as an assistant professor of family medicine.

Professional expectations

Most physician offices have students sign detailed agreements of confidentiality to help ensure that patient information is not discussed outside of the practice. Beyond respecting patient privacy, premeds must adhere to strict standards of professionalism.

Inspired to be a mentor by Dr. Pham, Dr. Akhtar has high expectations of the premeds who now shadow her. First and foremost, she says, students need to show up on the day and at the time they are expected. She recalls one student she had not previously met who said he would be at her office at 8 a.m. one morning but didn’t show up until 2 p.m. the following day. As if that weren’t bad enough, he asked Dr. Akhtar if she would write him a letter of recommendation. She refused to do so.

“I expect punctuality from students,” she says. “Show up at the time you say you are going to. I tell students, ‘You carry the standards of professionalism with you from this point forward.’ ” Premedical students should be respectful of everyone they interact with during the shadowing experience, including patients, physicians, nurses and office staff, Dr. Akhtar says.

Premeds who shadow DOs should dress in at least business casual attire, which means no jeans and T-shirts. But Dr. Akhtar notes that what is considered appropriate attire varies regionally. Khakis and boots may be acceptable professional dress in Portland but not in Chicago or New York City, she points out.

Although some physicians may comment to shadows while going about daily routines, many expect students to be silent observers. Especially when patients are present, students should refrain from making remarks, which could be distracting, Dr. Akhtar says. Because she spends just 15 minutes or so with each patient, quickly proceeding from one to the next, she prefers that students save their questions until the end of the day’s shadowing session. But this preference varies with the physician. Students should inquire when it would be appropriate to ask questions.

At academic medical centers, patients are used to seeing trainees at all levels, so premed students generally are not unwelcome, Dr. Akhtar says. But some patients do not want any students to be present. In those situations, she has students wait in her office.

Dr. Akhtar keeps her shadows busy. “I frequently will have students look up information. This is very helpful to me, and the students learn a lot,” she says.

She tries to give premeds a sense of what is expected of med students on rotation. “For example, they should not ask me if they can go home early because that would suggest they are not interested in learning,” she says. “Like med students, premeds should follow the physician’s schedule and go home when the physician goes home.”

Premeds seek out Dr. Akhtar to shadow specifically because she is a DO in a mainly MD institution. “Some of these students are not sure yet whether they want to become DOs,” she says. “This is a decision they will have to make for themselves. Shadowing experiences will help them make the right choice.”

Correction: This article was updated to remove the name of an outdated internship program.

cschierhorn@osteopathic.org

One Response

  1. American College of Clinical Information Managers (ACCIM) on July 6, 2012, 3:57 p.m.

    Thank you for sharing “A day in the Life” to give many pre-medical/medical scribes a glimpse into achieving their goals and coming prepared to perform at high caliber.

    ACCIM certifies Medical Scribes as Clinical Information Managers with CIMCAT certification to ensure competent knowledge base applied shadowing physician and enhance opportunities of acceptance into medical school. Recommendations from physicians are another helpful attribute. Great article!

    Kristin Hagen, CPEHR, CPHIE, CPHIT
    ACCIM Executive Director

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