Ethical Shadowing Abroad:
Respecting Patients While Gaining Valuable Insights

OR Shadowing students

As a nursing student, Maria had spent weeks shadowing various healthcare professionals. But when she walked into the room of an elderly patient, something caught her attention. The way he smiled at her seemed familiar, and as she looked closer, she realized that he resembled her grandfather who had passed away years ago. Suddenly, Maria's professional demeanor melted away, and she saw the patient as more than just another person to care for. She empathized with his loneliness and vulnerability, and found herself spending extra time chatting with him and holding his hand.

First, do no harm.

The practice of clinical shadowing can provide valuable insights and experiences for aspiring healthcare professionals. 


However, it is important to ensure that this practice is conducted in an ethical manner that respects the privacy and autonomy of patients.


Ethical shadowing involves obtaining appropriate consent from patients, maintaining confidentiality and privacy, and following appropriate professional conduct standards.


By adhering to ethical principles, shadowing can provide a valuable opportunity for students to gain firsthand knowledge and experience of the healthcare profession, while also maintaining the trust and respect of patients and healthcare professionals.

Additional challenges of abroad healthcare professionals shadowing

In recent years, an increasing number of students in healthcare and premedical students have been traveling abroad to gain clinical experience.

While these opportunities can be incredibly enriching and educational, they also pose a unique set of challenges and risks.


In particular, during clinical experiences abroad students must navigate cultural differences, language barriers, and varying standards of care. To ensure the safety of both patients and students, it is essential that students and study abroad providers follow guidelines for providing patient care during clinical experiences abroad. 


It is crucial for shadowing students abroad to prioritize patient safety and avoid causing harm. This requires careful attention to both the patient’s physical and emotional well-being.


As a student, it may be challenging to determine what actions could potentially cause harm, so it is essential to err on the side of caution and avoid situations where there is any possibility of injuring someone or causing other harm.

A great place to begin is by referring to the AAMC Guidelines for providing care during clinical experiences abroad.”

What do patients really think about students shadowing their doctors?

Shadowing physicians is a crucial part of medical education and training, providing students with firsthand knowledge and experience of the healthcare profession. However, this practice raises ethical concerns regarding patient confidentiality and trust.


Critics of having college students present in the clinical setting argue that it may compromise the quality of care provided to the patient.


Furthermore, they say, some patients may feel uncomfortable or even violated with the presence of an unfamiliar individual during their medical procedures.


To better understand patients’ perceptions of physician shadowing by college students, a study was conducted in 2014, which examined patients’ attitudes and experiences. 


The findings of this study provide insight into the importance of ethical shadowing practices and highlight the need for ongoing discussions between patients, physicians, and students.


In 2014, a study showed that most of the patients didn’t worry about their personal information being shared with shadowing students(87.5% of them didn’t have any concerns about their privacy).

The study, which took place at two outpatient family medicine centers, involved 32 patients who agreed to have a college student shadow their physician. Patients participated in semi-structured interviews during July and August 2013, and qualitative techniques were utilized to analyze the transcripts and identify common themes.

The majority of patients (78.1%) felt that the college student had a neutral effect on their visit and denied having concerns about confidentiality (87.5%). No patient felt that having the college student present affected their ability to maintain a trusting relationship with their physician. Three themes emerged from the qualitative analysis: benefits to students, willing participation, and sensitive issues.


The first theme, benefits to students, refers to the positive impact that shadowing can have on the educational and professional development of students.


Patients recognized the importance of shadowing a doctor for students, with 78.5% of patients recognizing that the student was in college or was a pre-medical student.


Many patients believed that shadowing could help students gain a better understanding of the healthcare profession and develop the skills and competencies needed to become effective healthcare professionals.

The second theme, willing participation, highlights the importance of obtaining appropriate consent from patients before shadowing takes place.


The study found that patients were generally willing to participate in shadowing, with the overwhelming majority of patients stating that they would have a college student shadow their physician again in the future.


This willingness to participate reflects the trust and confidence that patients have in their physicians and the healthcare system.


The third theme, sensitive issues, relates to the potential ethical concerns that may arise during the shadowing process.


Patients expressed concerns about the possibility of students sharing confidential information with others or violating their privacy.


However, the study found that these concerns were largely unfounded, with the majority of patients feeling that their privacy and confidentiality were respected during the shadowing process.

The results of this study suggest that patients are generally receptive to shadowing and recognize the benefits it provides to students. However, it is crucial that shadowing is conducted in a manner that respects patient privacy and confidentiality, and that appropriate consent is obtained before shadowing takes place.


By understanding patients’ perceptions and concerns, physicians and students can work together to ensure that the practice of shadowing is conducted in a respectful and ethical manner, benefiting both students and patients alike.

Balancing Privacy and Education: The Italian Law on Student Shadowing in Teaching Hospitals

In 2005, the Italian Data Protection Authority (DPA) amended the Italian privacy law regarding the specific case of students shadowing doctors in teaching hospitals. This amendment was made to ensure that the dignity of patients being treated at academic hospitals was protected, and that their privacy and confidentiality were not compromised by the presence of student shadowing.

Under the amended law, patients must be informed that in addition to preventive and care purposes, didactic purposes are also pursued. 


This means that patients need to be made aware that students may be present during their treatment, and that their presence serves an educational purpose. It is essential that patients have a clear understanding of the purpose of student shadowing, so that they can make informed decisions regarding their participation.

Shadowing student walking a hospital corridor during the Doctors in Italy Fellowship

Furthermore, patients are required to give their explicit consent for student shadowing, which they can deny at any time.


This means that patients have the right to decide whether or not they are comfortable with the presence of a student during their treatment. Patients can deny consent for student shadowing at any point during their treatment, and this decision must be respected.


It is also important to note that students who are shadowing doctors in teaching hospitals are bound by the same confidentiality obligations as any other healthcare professional working at the hospital.


This means that they are required to maintain the same level of confidentiality and privacy as other healthcare professionals, and that they must adhere to the same ethical standards.


Prioritizing Patient Consent in Physician Shadowing: A Solution to Address Concerns of Subtle Coercion

Do patients feel compelled to allow students into the examination room if their physician requests it? After all, patients may feel obliged to maintain a positive relationship with their healthcare provider, which could influence their decision to allow students to shadow during their examination.


However, this intrusion can leave patients feeling uncomfortable or resentful during what should be a private and personal interaction.


To address these concerns, it’s important to change the way that consent is obtained for the presence of students during patient-physician encounters.


Instead of leaving it up to the physician to request permission, staff members should be the ones to ask for consent from the patient. This request should occur outside of the presence of both the physician and the student, and emphasize the patient’s right to decline.


By taking this approach, patients can feel more in control of their healthcare experiences, and be more comfortable with the presence of students during their interactions with physicians.


Additionally, it can help prevent any misunderstandings or potential feelings of coercion that may arise when the request for student involvement comes directly from the physician.


By emphasizing the importance of patient consent in the process of physician shadowing, healthcare providers can help ensure that students are able to learn and grow in their professions, while also prioritizing the privacy and comfort of their patients

Addressing Concerns of Misrepresentation: Ensuring Clear Identification for Students Shadowing Healthcare Professionals in Clinical Settings

In clinical settings, patients rely on healthcare professionals to provide them with accurate and trustworthy medical care.


This requires a high level of trust and transparency between patients and healthcare professionals. When students are introduced into the mix, it’s important to ensure that there are no misunderstandings or misrepresentations about their role and status.


Concerns have been raised that shadowing students may be misrepresented as healthcare professionals. This could create confusion and mistrust between patients and the healthcare team. Patients may feel uncomfortable or unwilling to participate in educational experiences if they feel that they are being misled or taken advantage of.


Student shadowing doctors abroad with a white coat and a scrub

By providing clear identification for students, such as badges or signs on their white coats, patients can easily recognize them as students rather than healthcare professionals.


This can help alleviate concerns about misrepresentation and ensure that patients are fully aware of the role that students are playing in their care.

Providing clear identification for students in clinical settings is an important step in maintaining transparency and trust between patients and healthcare professionals.

In Italy, it is common for hospitals to display posters (like this one from our partner AOU Careggi in Florence) throughout the wards and rooms showcasing the different types of dress worn by healthcare professionals. These posters serve as a visual aid for patients and visitors, helping them to easily identify and distinguish between the various healthcare professionals they may encounter during their stay at the hospital. By providing this information in a clear and accessible way, these posters can help prevent misunderstandings and misrepresentations of healthcare professionals and their roles.

Informative poster displayed at Careggi Hospital in Florence, designed to assist patients in identifying various healthcare staff members by their uniform colors and styles

The Surprising Benefits of Having College Students Present in Patient Care

Having college students present during patient care has the potential to impact patient welfare positively. Not only does it provide an opportunity for students to learn from experienced healthcare professionals, but it can also potentially enhance the doctor-patient relationship and lead to better clinical outcomes.

For doctors, being observed by students may encourage them to demonstrate ideal clinical behavior. When someone is watching, doctors may be more likely to follow evidence-based practices and adhere to professional standards, improving the quality of care and reducing medical errors.

Furthermore, having students present can increase patients’ trust in their doctors. Patients may feel more confident in the care they receive knowing that a student has come from another country to learn from their doctor, enhancing the healing power of the physician.

The purpose of shadowing by college students is not solely for them to gain admission to a professional school or choose a career path. It is an opportunity for students to learn compassion, understand what it is like to give good and bad news, and to be closer to and understand suffering. Ultimately, this experience can help students become better professionals and better human beings, benefiting society as a whole.

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