Shadowing afoundation-year doctor:a third-year medicalstudent’s perspectivePhilippa Graham, Barts and the London Medical School, London, UKSimon Tso, Acute Care Unit, Homerton University Hospital NHS Foundation Trust, London, UKEleanor Wood, Academic Department of Medical and Surgical Gastroenterology, HomertonUniversity Hospital NHS Foundation Trust, London, UK

SUMMARYContext: This paper considers theadvantages of shadowing founda-tion-year doctors (FY1) in thethird year of medical school, anopportunity the UK’s GeneralMedical Council (UKGMC) recom-mends to be given to final-yearstudents only.Method: Eighteen students spent1 day each shadowing an FY1,holding their pager and carryingout their duties under directsupervision. Questionnaires,based on UKGMC expectations ofan FY1, were completed assessingstudents’ confidence andexperience before and after theshifts. The doctors wereinterviewed.

Results: The questionnaireresponse rate was 72 per cent(13 ⁄ 18). The overall increase instudent experiences in good clin-ical care (p < 0.001), maintaininggood medical practice – teachingand learning (p = 0.002), andrecognition and management ofthe acutely ill (p < 0.001), werestatistically significant. The in-crease in student confidence inanswering the pager (p < 0.001),prioritising jobs (p = 0.002),venepuncture (p = 0.008), writ-ing drug charts (p = 0.031),writing in patient notes(p = 0.002) and developing man-agement plans (p = 0.002) werestatistically significant. Qualita-tive results yielded an over-

whelming opinion from studentsand doctors that it should bemade a compulsory part of thethird-year curriculum. The doctorsfound it increased their knowl-edge and teaching skills.Conclusion: This study hasimplications for the future ofmedical training. If incorporatedinto the third-year curriculum,compulsory shadowing would givestudents a structured one-to-onelearning experience during whichto learn clinically relevant skills.By shadowing a doctor so closely,they will also learn first-hand howto interact professionally withpatients and other health careworkers, a skill difficult to teachat medical school.

Shadowingwould givestudents a

structured one-to-one learning

experience

Learningin a clinicalsetting

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INTRODUCTION

The UK’s General MedicalCouncil states the principlesof professional practice that

should be the basis of medicaleducation: good clinical care;relationships with patients; main-taining medical standards; work-ing with colleagues; and teachingand training.1 Students are rec-ommended to shadow a founda-tion year-1 (FY1) doctor (UK FY1doctors are in their first postgrad-uate year of training, but do nothave a full licence to practicemedicine unsupervised) for a weekas close to the point of employ-ment as possible so that they‘become familiar with the facilitiesavailable, the environment andget to know their colleagues’.1

Literature supports the view thatshadowing is a valuable andeffective learning tool,2 and themain requirement for clinicalworkplace learning is ‘supportedparticipation’, which reinforcesstudents’ ability to participate infurther practice.3 Shadowingexperiences would therefore facil-itate this effective way of learn-ing, and help students develop thepractical competence and state ofmind that is necessary for them tobecome medical professionals.3

Shadowing is offered to final-year medical students at Barts andthe London School of Medicineand Dentistry. This article con-siders the benefits of introducingthe shadowing of FY1 doctors bystudents for 1 day during theirthird year of medical training.

METHOD

Between October and November2009, 18 of 24 (75%) third-yearstudents in the metabolic medi-cine rotation at the HomertonUniversity Hospital participatedin the study. Fourteen studentscompleted their shadowing ingastroenterology, and four stu-dents completed their shadowingin trauma and orthopaedics. Theparticipants held the pager andassisted or carried out the daily

duties of the FY1 doctors underdirect supervision. The FY1 doc-tors could stop the shadowing atany point if they felt their clinicalduties were compromised.

The participants completedquestionnaires before and aftershadowing to assess perceivedlevels of confidence in the variousjobs, and perceived levels ofexperience in the following areas:good clinical care; maintaininggood medical practice – teachingand learning; and the recognitionand management of the acutelyill. Participants were also invitedto comment on their experience.

The response rate to thequestionnaire was 72 per cent(13 ⁄ 18). Data was collected usingthe five-point Likert scale andanalysed with the Wilcoxonsigned-rank test.

Four FY1 doctors participatedin the study, and individualface-to-face interviews wereconducted.

RESULTS

None of the shadowing experi-ences were terminated throughFY1 doctors’ work beingcompromised.

Analysis showed the increasedexperiences in good clinical care(answering the pager, time man-agement and decision making),maintaining good medical prac-tice – teaching and learning(teaching and training), and rec-ognition and management of theacutely ill (clinical experiences,take management and dischargeplanning) were statistically sig-nificant. The increased confidencein answering the pager, prioritis-ing jobs, venepuncture, writingdrug charts, writing in patientnotes and developing manage-ment plans were statistically sig-nificant (Table 1).

The students reported theexperience helped them to

appreciate the realities of an FY1doctor’s role and increased theirmotivation.

It’s good to see how thingsfit together.

They enjoyed the intensity ofthe shadowing.

Felt like I could contributemore to care other thansolely observing ⁄onlyclerking.

Some had suggestions forfuture shadowing.

Perhaps more practicalinvolvement as it waslargely observation based.

...some independencewhilst shadowing.

Interviews revealed that FY1doctors found the experiencehelped their teaching skills andtheir own knowledge, and sug-gested ways of improving it.

It will be mutually beneficialto students and doctor if itwas for longer and morestructured: they could thenbe fully integrated into theteam.

...keep the shadowing tothe less busy firms with less

Shadowing is avaluable andeffectivelearning tool

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sick patients so that thedoctor can give more timeto the student.

The qualitative results yieldedpositive feedback, with everystudent and foundation-yeardoctor reporting that they feltshadowing should be a compul-sory part of third-year training.

DISCUSSION

The experience gained by third-year students can vary widely.Often students are in large groupsreceiving a limited level of per-sonal tuition. The one-to-onenature of shadowing provides thestudent with a ward experience

and quality time with a doctor,resulting in the acquisition ofessential clinical skills. Literaturereview suggests that beingobserved during patient and staffcontact teaches the student tointeract professionally, a skillknown to be difficult to teach.4

With reduced training hours, as aresult of the introduction of theEuropean Working Time Directive,and the continuing concernsabout the preparedness of newlyqualified doctors for their firstclinical post,5 it is crucial that thequality of student’s learning isoptimised.

We have conducted a survey ofthird-year students’ self-perceived

experiences and confidence in thevarious areas of professionalpractice before and after a day ofone-to-one unstructured shadow-ing. The statistically significantresults indicate that studentsbenefited from certain aspects ofprofessional practice directly re-lated to the everyday ward-basedtasks of an FY1 doctor, e.g.answering the pager within goodclinical care, and clinical experi-ences within recognition andmanagement of the acutely ill.Other areas that shadowing didnot appear to have any impact on,e.g. clinical governance andaudit, would be best addressedusing other teaching methods.Qualitative feedback indicated aneed for more structure. Using theresults to build a curriculum mapand set learning objectives for a1-day structured shadowingexperience would further improvethe quality of the learning.

LimitationsThis is an uncontrolled studyusing a small volunteer sample,thereby limiting its generalis-ability. By increasing the samplesize, statistical significance maybe reached in the categories thatshowed some increase in experi-ence or confidence, but which didnot reach statistical significance,e.g. clerking patients. Incorpo-rating different specialties wouldenable the development offocused ‘specialty-specific’

Table 1. Tasks in which statistically significantimprovement in confidence and experience werereported by participants after shadowing

ExperiencesScore beforeshadowing

Score aftershadowing

p

Area 1: good clinical care 254 306 <0.001

Answering the pager 16 35 <0.001

Time management and decision making 30 38 0.016

Area 2: maintaining good medicalpractice – teaching and learning

231 252 0.002

Teaching and training 22 28 0.031

Area 3: recognition andmanagement of the acutely ill

77 106 <0.001

Clinical experiences 23 32 0.008

Discharge planning 16 27 0.008

Take management 16 23 0.031

Confidence

Answering the pager 27 42 <0.001

Prioritising jobs 32 44 0.002

Writing in patient notes 33 47 0.002

Developing management plans 23 35 0.002

Venepuncture 34 42 0.008

Writing drug charts 25 32 0.031

p values derived by comparing the 13 participants’ individual scores beforeand after the shadowing experience.

Score before shadowing: total sum of participants’ scores before theshadowing experience.

Score after shadowing: total sum of participants’ scores after the shadowingexperience.

Shadowingprovides the

student with award experienceand quality time

with a doctor

158 � Blackwell Publishing Ltd 2011. THE CLINICAL TEACHER 2011; 8: 156–159

learning objectives facilitatingthe introduction of a shadowingexperience for all third-yearstudents.

CONCLUSION

This study demonstrates the ben-efits of shadowing during thethird year of medical training. We

plan to implement such an expe-rience for all third-year medicalstudents at Barts and the LondonSchool of Medicine and Dentistryparticipating in the metabolicmedicine rotation at the Homer-ton University Hospital. We wouldrecommend that this becomes acompulsory part of the third-yearcurriculum.

REFERENCES

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Scherpbier A. Experience-based

learning: a model linking the

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4. Sivalangam N. Teaching and Learning

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Ann Acad Med Singapore 2004;33:

706–710.

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Corresponding author’s contact details: Philippa Graham, 6 Riversdale Road, Highbury, London, N5 2JP, UK. E-mail: pippagraham@gmail.com

Funding: None.

Conflict of interest: None.

Ethical approval: This paper does not describe research on human subjects, therefore ethical approval was not deemed necessary.

Results indicatethat studentsbenefited fromcertain aspectsof professionalpractice directlyrelated toeveryday ward-based tasks

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