Med Student Shadowing – Think Out Loud

Being a hospital associated with a medical school, we’re bound to have students interested in emergency medicine — even M1’s. Some of them may want to hang out with us in the ER to get a feel of what it’s like.

I know what you’re thinking: They don’t know enough of anything to be helpful. I don’t have time to spend explaining everything to them: like “what does CHF stands for?” and “why did you give them motrin instead of ibuprofen?” I can’t even go to the bathroom without them following me. If I can make a couple of sharp turns and duck into the juice room, maybe I can lose the student. Or maybe I’ll have them look something up in Rosens, that’ll get them out of my hair for an hour or two.

However, there is a way to make shadowing informative for the student, enjoyable for the patient and create minimal time disruption to you.

First, ask the patient if it’s okay to have a student in the room. Introduce the student as an observer, and ask the patient and family if it’s okay if he or she hangs out in the room. More importantly let the patient know you’ll be thinking out loud to help the student understand your thought processes. Tell them you may use medical jargon, and if they (the patient) doesn’t understand they should feel free to ask questions.

Then go through the patient evaluation, but THINK OUT LOUD. Let the student know what you’re thinking and why you’re doing things. “I’m asking these questions to rule out a PE, remember patients who are truck drivers are at increased risk for thromboembolism… what? Oh, that’s a blood clot.” “I’m hearing crackles at this left base, possibly signifying a pneumonia.” “Now we’ll order an EKG to check for cardiac causes.”

Patient’s love this because it gives them a rare peek into how we doctor’s think. It’s a glimpse into something interesting to them. Plus many patients are more than willing to help a student learn. It feels good to be part of the education process. The student also gets a glimpse into how we think, rather than just chasing us around and wondering “why did he ask about cocaine use?” or “what does that swollen leg mean?”

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