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zhaohan medical shadowing
Zhaohan (far left) and classmates from the Class of 2020

I'm Zhaohan, a first year student from the Duke-NUS Medical School. I'm also a trained and qualified lawyer of the Singapore Bar, having previously read law at the National University of Singapore. I applied to Duke-NUS in the knowledge that a life in medicine was for me, and like my peers, I've run the gamut of experiences to prepare myself for applying to medical school. Some of these experiences include work shadowing opportunities with physicians. If you'd like to know more about how best to make use of such opportunities, this article may be for you.

Why Work Shadowing?

Shadowing a doctor is a relatively simple means by which one finds out what it is like to be a doctor in medical practice, without actually being one. Although your mileage may vary, this can serve as a valuable experience to help you make an informed decision as to whether a life in medicine is for you. For graduate school applicants, shadowing a doctor can be especially useful for individuals whose educational backgrounds tend not to allow them the opportunity of doing work involving doctors in a care setting.

What are your options?

At the outset, be aware that you may either reach out to individual doctors or write to hospitals for work shadowing opportunities, be they in the private or public healthcare sectors. Generally, your chances of being taken in depend on: a) the available time and vacancies that a doctor or the hospital has, b) the existence of established work shadowing programmes (for applications to hospitals, or requests made to doctors working in hospitals), and c) the administrative policies that govern such doctors and hospitals.

On structured programmes: Major hospitals in Singapore tend to have structured programmes for shadowing medical professionals. In my (dated) experience with the National University Hospital and Mount Alvernia Hospital, these span three to five workdays, and comprise of a whistle-stop tour of the hospital's facilities, in addition to brief attachments to individual doctors from a single department, or across multiple departments. (These programmes may indicate that priority is to be given to JC students - therefore if you are not currently one, always be prepared to write in to the relevant hospital departments or administrators for consideration on an ad hoc basis. You should be prepared to explain your background and to state your reasons for applying for such programmes.)

In contrast to restructured (public) hospitals, private hospitals tend not to have structured programmes. However, such private hospitals seem open to having students who are taken in by the hospital's doctors for shadowing opportunities.

In general, structured programmes give a fair overview of what it is like to work in a hospital, but tend not to give you a good idea of the full range of doctor's life on a day-to-day basis. This is on account of the short duration of such programmes. If possible, you should look for opportunities to shadow individual doctors for more than a week.

Here are a few rules of thumb:

• Always write in early to enquire about opportunities. For structured programmes, it would not be unusual to write in at least half a year in advance - having written in two to three months in advance, I was fortunate to have been considered for one.

• Find out about opportunities at as many hospitals as possible to maximise your chances. You may like to keep track of such opportunities and the status of your applications by making records in a table or spreadsheet.

• Always be polite and concise when making enquiries. A resume would likely be helpful when reaching out to individual doctors, as it can assist with summing up your background in an organised manner.

• Be prepared to submit paperwork, which may include proof of your educational background, health insurance and vaccination status.

Ground rules

Your conduct should be informed by the respect you should be giving to the doctor you are shadowing, his or her healthcare team, and most importantly, the patient. Being there at their sufferance, you should not make the jobs of the doctor and the team any more difficult than they are, nor abuse the trust and confidence that the patient has placed in them.

• Dress professionally and modestly. Wear covered shoes and short sleeves (or rolled-up long sleeves) for your safety and infection control. Keep your hair tidy and your nails short and uncoloured.

• Be punctual. It is preferable to arrive slightly earlier than you have to.

• Be as discreet as you can. In most situations, never interrupt a patient's consultation with the doctor or a procedure. Reserve your questions for appropriate junctures.

• Respect patient confidentiality. In particular, never take pictures of patients and of anything that might identify them or their visits, and do not discuss patient information in public.

• In general, be observant and learn on the "job".

How to make the most out of your experience

• Keep a notebook. Make a note of your experiences. Memory is fallible, and you will want to be able to look back upon your experiences and reflect intelligibly upon them in the future, be it for your own self-knowledge or your application to a medical school. You may also like to make a note of anything that you do not understand, so that you may check it up at a later juncture. (Try not to use your phone for this. It is easily construed as a sign of disrespect, particularly if you should be thought of as being preoccupied with something else).

• Offer help within your competence. Do this in recognition of the fact that your being there probably makes your doctor's job harder than it already is, and his or her patients more ill at ease than they already are. For example, while I was at an orthopedic clinic, with the permission of the doctor I was shadowing, I would often help him or the nurse change the covering of paper towels on the examination bed in between consultations.

• Do your research. As soon as is possible, try to find out what area of medicine or what sort of medical practice you will be exposed to, and read around generally on that. It may be profitable to read very briefly and broadly on gross anatomy and basic physiology. It is especially helpful to learn the (medical) names of relevant medical conditions and procedures, and local clinical shorthand (e.g. "Dx" for diagnosis, "TCU" for next follow-up appointment).

• Always clarify your doubts and ask sensible questions at appropriate junctures. Your questions need not, and should not be restricted to those concerning medical knowledge - remember always that you are there to find out what it means to work in the healthcare industry.

• Observe, talk to and learn about people in the work environment other than the doctor you are shadowing. These include the nurses and allied health practitioners. Medicine is team-based, and therefore a career in medicine must be appreciated from an awareness of their roles in healthcare, and beyond the singular perspective of the physician alone.

• It is especially valuable to interact with doctors of different seniorities (such opportunities arise easily in in restructured hospitals, where your doctor almost inevitably works with a team of physicians of varying seniorities). Owing to their varied experiences and the different challenges which they each have to face, they invariably have different perspectives and opinions worth listening to. In particular, you may like to ask these doctors about the many hoops that they have had to jump through to get to where they are, what they have to face on a regular basis during a typical day at work, what keeps them going, and their hopes and fears for the future. These are all things that will be part of your experience, should you choose to walk in their footsteps.

Lessons learned from my work shadowing experiences

Here are three key points featuring a little of what I have learned following my work shadowing experiences, with which I will conclude this article.

First, work shadowing should not be treated like a box waiting to be checked on a medical school application. It bears repeating that it is an opportunity to help you make an informed decision as to whether a life in medicine is for you, and you should make it work for you to that end.

To make my work shadowing opportunities work to such an end, on my part, these were some questions which I repeatedly asked of myself during my attachments, and sought answers for: "Would I be comfortable in the roles which I have seen these doctors play? Is this the sort of environment I want to be working in? Are these the people I want to be working with?" All that I saw allowed me to conclude that while a doctor's life and training was no bed of roses, it offered a career and a way of living that was consonant with the identity I wanted for myself for the foreseeable future: I wanted to be part of the culture of continuous teaching and learning that I saw in restructured hospitals; for I have always taken pleasure in learning from the best and passing on knowledge to others. I took heart in observing how one is never alone when working as a hospitalist; one soon realises that together with nurses, pharmacists, physiotherapists and technicians, a doctor strives constantly to co-ordinate team-based care from within the eye of the storm. Moreover, I admired the character, composure and drive which many of the medical professionals seemed to possess; not only was this an environment which I found myself wishing to thrive in, more importantly, I knew that the people I had met were people I wanted to work with.

Second, I would encourage you to always look beyond the facts, figures, routines and protocols, and experience how intimately medicine is in the business of dealing with lives. In medical practice, the richly coloured threads of human stories often lie in plain sight, and when woven together, form a many-hued tapestry that represents life in our society. I think it to be an incredible privilege to have sight of this throughout one's career. On this note, two patients from my work shadowing experiences and the learning which I derived from meeting each of them come to mind.

• The first was an elderly man in his eighties who was recently admitted from a nursing care home. He was very much awake but non-responsive, wracked as he was with severe infections in his chest, urinary tract and a collection of large sacral sores. It was clear that his life had outlasted his hold on health, and that he was too far gone to receive any therapeutic care that would lead to meaningful improvement. A decision to put him on palliative care was made to gently usher him through to his eventual demise. It is one thing to hear and read about end-of-life care and the medicalisation of death in modern medicine, but quite another to witness it and the process of dying firsthand. In doing so, I appreciated more viscerally and fully the gravity of end-of-life care and its implications.

• The second was a lady in her fifties who was brought in to the emergency department after having fainted at a bus stop. She had no previous medical record – she claimed being unable to pay for any medical care. She had poor social support, lived alone, and worked as a cleaner. She complained of abdominal pain and vomiting, as a result of which she alleged she had no appetite and had not eaten for three days. On examination, she was found to have a sizeable mass on her breast - likely malignant - which had been growing for three months or more. Upon further examination and preliminary investigations, she was also found to have psoriasis, and urine and fungal infections. She was left to the care of physicians from the dermatology and oncology departments before being admitted to a ward, alone and afraid. Her case reminded me that debilitating conditions and their complications are so much more than phenomena described in a textbook: they do not occur in a vacuum, and it is poverty and a lack of social support that often underscores the extent of their devastation.

Finally, it must be said that work shadowing will likely not provide you with a complete picture of a life in medicine. It is but one experience out of many which you must seek and put together to come to your own conclusions. On my part: a) To learn more about the pastoral aspect of medicine, I served as a ward volunteer tending to fall-risk and disoriented patients on the night shift; b) in a bid to expose myself to work in a primary care and community setting, I assisted with clinic administration and the dispensing of medicine at a non-profit organisation dedicated to supporting migrant workers and the poor; and c) to better understand clinical research and academic medicine, I worked full-time as a clinical research coordinator. These are but some of the avenues which you can explore in your bid to attain the requisite experience to ground your conviction that practising medicine will ultimately be for you.

The path to discovering your calling in medicine and applying to medical school can be a daunting process. With that in mind, it is hoped that this article will be of use to you in your journey. In the meanwhile, put one foot in front of the other, and persevere. Good luck!

By: Goh Zhaohan (Class of 2020)