Entering a physician's office for a visit and examination
may allow you to be a participant in a medical exercise called
"pre-medical shadowing". This
means that, hopefully with your full informed consent, a college student called a "pre-med
student" who has been studying courses to apply to medical school, will be
present to learn what the practice of medicine is all about as seen within the
office of a doctor in practice. Some medical educators believe that if these college students "shadow"(watch)
professional physicians at work they
will get some insight into the profession before applying to medical school and
their education in this regard may be of some value.
Though, as a medical educator and physician myself, I find
some value in this "shadowing" I do have some concerns and I
expressed my opinion to a medical education website as follows:
Does anyone think that "clinical shadowing" by pre-med
students will, whatever the benefits from the experience, also instill elements
of the "hidden curriculum" taught to 3rd and 4th year students and
beyond even before experiencing the more "humanistic" learning
provided 1st and 2nd year students? Or am I becoming overly concerned?
The "hidden curriculum" is defined as being the education
of these students and residents by experience mature superiors who promote
their own view of medical practice in a way different and perhaps more
organizational and bureaucratic but perhaps less humanistic from what their
subjects learned in the earlier years of medical school.
A medical educator responded to the website with the
Maurice's question is a good one, and one on which my colleagues and I
have been reflecting. We have seen evidence of the interference of the
shadow in the ways M1 and M2 students make patient notes, using abbreviations
that are no longer acceptable or are short-hand used by physicians who learned
the longer versions first. We have also seen evidence in the ways in
which students talk about patients: non-compliant; drug seekers;
physician-centered, disease-first speak rather than patient-centered,
The phenomenon seems to be a bit akin to rituals of tribal acceptance.
Medical students are in school to become part of a given subculture, the
tribe of medicine. They may have different reasons for doing so, but the
end point is the same: join a culture with its own language, behaviors, norms,
and so on. If they shadow members of this culture, tribal elders who were
trained to behave in certain ways, then go to an educational institution that
attempts to tell them to behave otherwise, it would seem rational for them to
comply with the institution externally but with the tribal elder internally.
The elder is practicing in the field and therefore seems to have more
social capital than institutional pre-clinical educators.
This is a particularly interesting phenomenon given that medical
schools are working on creating future leaders for a medical culture that is
itself in the midst of an intense transformation. The tension between
tribal tradition and transformational innovation is palpable, manifesting in a
variety of ways including the necessary use of practicing elders as faculty and
mentors for said future leaders.
Shadowing may help pre-matriculants to get a better grasp on the daily
routines of the profession, but it may also be contributing to a prior
knowledge base that hinders development of the medical culture.
What I find of importance in this response is regarding the
possible effect of this "shadowing" on inhibiting the medical profession to advance medical
practice from "old tribal tradition" to new ways, in new times, to
improve the patient's value from the doctor-patient relationship.
There is much more to consider regarding this issue of "shadowing" by some undergraduate college student including issues of patient privacy with regard to both sensitive history taking, physical examination and the physician's discussion of emotionally sensitive conclusions with the patient with a student in attendance.
I would be most interested to read what my visitors here
think about "shadowing" by pre-medical college students. ..Maurice.
Graphic: From Google Images.