Job Shadowing: Observers, Volunteers, and Students in Clinical Settings

Kim Hathaway, MSN, CPHRM, Patient Safety Healthcare Quality and Risk Management Consultant, The Doctors Company

It is not unusual for healthcare providers to receive requests from students seeking opportunities to shadow or observe, volunteer, or learn through a formal clinical rotation. High schools may offer programs and courses that focus on health-related careers. Healthcare professionals also receive requests for shadowing experiences from college and vocational students.

Understanding what being a healthcare professional entails is critical for any individual considering a career in the industry. Shadowing or observing, volunteering, and mentoring opportunities may be rewarding for the professional and benefit the learner by fulfilling requisite application criteria. Although it is a great opportunity to promote your profession, it is also important to recognize the risks to your patients and your practice if you decide to accommodate such requests.

Before deciding to allow students into your practice, explore their expectations and the impact it could have on your practice. Identify and validate the program associated with the request and understand the objectives that are expected to be achieved. It is important for the practice to differentiate between shadowing or observing, volunteering, and a formal clinical rotation in which direct patient care is provided.

Shadowing or Observing

A shadowing or observing experience allows an individual to watch a professional provide care to patients in a clinical setting. Shadowing experiences, which are generally used as an introduction to the profession, allow the professional to mentor and model professionalism in the care and treatment of patients who have various conditions. These situations also provide opportunities to demonstrate sensitive communications with patients from diverse social, cultural, and financial backgrounds.

The observer may be associated with a formal school or vocational program. Often, shadowing a healthcare professional is required as part of an application process. In most cases, the individuals will not have a clinical instructor. These observational experiences are temporary, more informal, and do not involve patient care. To prevent harm, the professional should assess the observer’s education and training before deciding how the individual will interact with patients.

Volunteering

Volunteering is usually more structured than shadowing or observing. It does not, however, constitute education or training. Rather, volunteering provides unpaid experience in the clinical setting. Practices that accept volunteers should have defined processes and a role for the volunteer, such as a summer or holiday position for when regular staff may be on vacation. Volunteering should include an application process and an orientation. Determine the exact duties the volunteer will execute during the time period, such as answering phones, filing, or other duties that are supervised but do not involve patient care.

Clinical Rotation

A clinical rotation is part of a formal education program for healthcare professionals. The learner rotates through various settings to gain hands-on patient care experience. Clinical rotations are very structured. They include learning objectives, behavioral expectations, and a supervising clinical faculty member.

Depending on the type of program, the clinical preceptor may be a nurse, advanced practice clinician, dentist, or physician. The preceptor is approved by the educational program’s criteria. In such cases, the program usually has very structured objectives and approvals for practicum experiences. This type of clinical rotation or preceptorship is reserved for students near the end of the program. The practice should request and review any of the program’s clinical requirements or other documents that describe the relationship with the sponsoring practice.

Risk Management Strategies

Regardless of the situation—shadowing or observing, volunteering, or clinical rotation—it is vital to safeguard patients’ rights, privacy, and confidentiality. It is also the sponsoring clinical practice’s responsibility to ensure that the learner is mature enough to understand the practice’s expectations. The practice must institute controls to protect patients, staff, and the practice.

Consider the following strategies to help reduce the risks to your practice—including the risk of breaching patient confidentiality. These strategies may also help you identify the individual’s specific goals and objectives to make the experience mutually rewarding for the learner, patient, and practice.

• Ask for a formal written request for the learning experience that includes its length of time, purpose, objectives, and expectations. Requests for clinical rotations should also include a written contract with the educational institution that identifies liability responsibilities and outlines what to do if the student gets a needle stick, is exposed to blood-borne pathogens, or is otherwise injured on the property.
• Provide a brief application form or ask for a résumé that contains the learner’s personal information, including parent names and contact information, name of the school, current grade level, the school’s contact (counselor/advisor/faculty), and the specific purpose of the experience.
• Learn about the program by interviewing the student. The interview will also provide an opportunity to assess the student’s level of maturity and communication skills.
• Request one or two references or recommendations from a faculty member or other individual who can confirm the student’s character.
• Consider a liability waiver or release form executed by the parents or guardian if the student is a minor or if the setting includes any hazards, such as exposure to chemicals, lasers, or biological substances.
• Limit student observers to those who attend a structured program that provides instructions regarding professionalism, confidentiality, and state and federal privacy laws.
• Create a name badge that identifies the learner’s role clearly for office staff and patients.
• Develop an introduction process and ask patients for permission to allow the learner to observe the clinician-patient interaction. Inform patients that they may decline the request. Document patient consent.
• Have the student (and the parent or legal guardian if the individual is a minor) sign a confidentiality agreement.
• Develop a “code of conduct” and review expectations with the student. At a minimum, it should include guidelines that address professionalism, abusive language, breach of confidentiality, harassment, appropriate use of mobile devices, and dress code. The student should sign an agreement to abide by the code of conduct.
• Provide clear expectations regarding the appropriate time for questions and answers, such as during or after the interaction between the healthcare professional and the patient.
• Discuss infection control standards, including the necessity to stay home at the onset of symptoms of illness, and outline any mask mandates or other precautions in effect. Request a current TB skin test and proof of immunizations.
• Provide orientation to ensure that the student is prepared for the learning experience. The orientation should identify the professional mentor and outline the sponsoring practice’s expectations. It should also include training on HIPAA, universal precautions, and social media restrictions.
• Verify with your agent or broker that appropriate insurance coverage is in place before providing shadowing or observing, volunteering, or clinical experiences in your practice.

For guidance and assistance in addressing any patient safety or risk management concerns, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.

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