The patient was about to undergo surgery when the surgeon came into the hospital room with “a clan of about six ‘student doctors’.”
It was uncomfortable and embarrassing:
As the young students craned their necks to get better views of my condition, I remember feeling so overwhelmed and self-conscious that I didn’t voice any of the several concerns I had outlined to discuss with my surgeon. I’m ashamed to admit it, but I remained quiet as my surgeon prattled on about what he was going to do.
Now imagine the student doctors are high school or college-aged students who aren’t even in medical school yet but are job-shadowing a physician mentor to learn more about a possible career in medicine.
Does the discomfort level ratchet up even more?
Job shadowing is a time-honored way for teens and young adults to gain a firsthand look at what medicine is like so they can make informed, realistic choices about pursuing it as their life’s work, writes Dr. Elizabeth Kitsis, director of bioethics education and assistant professor of medicine at Albert Einstein College of Medicine in New York.
But she admits to feeling uneasy about its impact on patients and on their care.
She wonders: Do patients know the “student” observer in the exam room might actually be a high school student? Are they allowed to ask the student to stay out of the room? What if they don’t want a student present but are too shy or intimidated to say so?
More to the point, does the presence of a high school or college student inhibit the discussion of sensitive medical issues? Maybe the patient won’t bring up worries about having contracted a sexually transmitted infection, or might give less than honest answers about alcohol consumption, Dr. Kitsis writes.
She asks: “Are these concerns outweighed by the benefit derived by premed students from being in the room? I suspect that students would respond in the affirmative. But I am not sure what patients would say.”
To help answer some of these questions, Dr. Kitsis and a colleague turned to the research to conduct a study of their own. What they found was a dearth of information on best practices in medical job shadowing, how to measure the effectiveness of such programs and how to address the ethical and practical considerations.
She and Dr. Michelle Goldsammler concluded that more research is needed, and they suggest the development of guidelines and a code of conduct for premedical students who want to shadow a practicing physician.
Judging from the online conversation, most medical students find it valuable indeed to shadow an experienced physician to gain an understanding of a career they’re seriously considering.
Jimmy Tam Huy Pham, a medical student, shadowed in several different settings before entering medical school. Most patients were OK with having him in the room, although many others declined, he wrote.
“The bottom line is: exposure to any aspects of medicine (and as much of it as possible) is crucial for an individual who is about to spend the next 8-11 years of their life (subsequent to high school) in a profession where repetitive exposure and practice to procedures and patient interaction are keys to learn,” he wrote.
“Patients were always asked whether or not they were happy to have me present and, of course, their wishes always respected,” someone else wrote. “Personally, I feel that shadowing was invaluable in helping me to decide that I do truly want to pursue a career in medicine.”
Several people pointed out that shadowing experience is an unofficial entrance requirement at many medical schools in both the U.S. and the U.K.
Many of the patients who joined the online discussion had a different perspective, though.
“A curious teenager in my exam room? Never,” was one person’s response.
Someone else wrote that she did not want “some kid who has nothing to do with my care tagging along with my doctor.” Nor did she want to be in the position of having to say yes or no to allowing a student in the room, she wrote. “Why should patients have to go through that? It’s not the patient’s responsibility to help young people figure out if they want to be doctors.”
Previous studies have found that a majority of patients are willing to accept the involvement of medical students in their care – and that many in fact find it rewarding to help contribute to a student’s education. But most of these studies concentrated on students who have already entered medical school and are able to bring training and commitment to their encounters with patients. Does it – or should it – make a difference when the student is still in the career exploration phase?
Society holds a stake in the training of future health care professionals. After all, today’s student is tomorrow’s doctor, nurse, physical therapist or physician assistant. But do patients have a moral obligation to participate in this process? And when they do participate, what can be done to help ensure it doesn’t compromise their care or their privacy? It would seem these are questions that need to be examined and satisfactorily answered.