Job Shadowing: Observers and Volunteers in Medical and Dental Practices

Kim Hathaway, MSN, CPHRM, Patient Safety Healthcare Quality and Risk Management Consultant, Department of Patient Safety and Risk Management

It is not unusual for physicians and dentists to receive requests from students seeking an opportunity to shadow/observe, volunteer, or learn through a formal clinical rotation. Many high schools 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 it means to be a healthcare professional is critical for individuals who are considering a career in the healthcare industry. Shadowing/observing, volunteering, and mentoring opportunities may be rewarding for the professional and benefit the learner by fulfilling requisite application criteria. It is a great opportunity to promote your profession, but 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 they might 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 are generally used as an introduction to the profession. They provide the professional with an opportunity to mentor and model professionalism in the care and treatment of patients who have various conditions. It is also an opportunity 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. In many instances, shadowing a healthcare professional is required as part of an application process. In most cases, the individuals will not have a clinical instructor. These are temporary, more informal, observational experiences that 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 observation or shadowing. 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. Each practice should determine the exact duties the volunteer will execute during the volunteer’s term, such as answering phones, filing, or other duties that are supervised but do not involve patient care.

Clinical Rotation

A clinical rotation is generally 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 provider, 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 generally reserved for students near the end of the program. The practice should request and review any program 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 always protect patients’ rights, privacy, and confidentiality. It is also the responsibility of the sponsoring practice to ensure that the learner is mature enough to understand the expectations of the practice. 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 the practice.

  • Ask for a formal written request that includes the length of time, purpose, objectives, and expectations of the learning experience. 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 resume 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 clearly identifies the learner’s role to office staff and patients.
  • Develop an introduction process, and ask each patient for permission to allow the learner to observe the clinician-patient interaction. Inform the patient that he or she may decline the request. Document the patient’s 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 for 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. 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, 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 patientsafety@thedoctors.com or (800) 421-2368.


Resources

American Dental Education Association. Shadowing. www.adea.org/GoDental/Application_Prep/Preparing_for_Dental_School/Shadowing.aspx

American Medical Association. Code of Medical Ethics Opinion 3.1.2. Patient privacy and outside observers to the clinical encounter. www.ama-assn.org/delivering-care/ethics/patient-privacy-outside-observers-clinical-encounter

American Student Dental Association (ASDA) Blog. Six ways shadowing prepares you for dental school. www.asdablog.com/6-ways-shadowing-prepares-you-for-dental-school/

Association of American Medical Colleges. Shadowing a doctor. https://students-residents.aamc.org/applying-medical-school/article/shadowing-doctor/

National Association of Colleges and Employers. Position Statement: U.S. internships. www.naceweb.org/advocacy/position-statements/united-states-internships.aspx?land-intern-lp-3-adv-usint-01232015



The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J12413 06/20