Clinical Observation ("Shadowing")
(Pre-OT, PT, and PA students)
Clinical observation (or shadowing - here, we use the terms interchangeably) is NOT the same thing as volunteering or direct patient care. Clinical observation is exactly what it sounds like: you are observing a healthcare professional provide care to patients or clients in a clinical setting, such as a hospital, therapy clinic, long term care facility, private practice, and so on. Through clinical observation experiences, you see what the day-to-day responsibilities of a given health career might involve within a given healthcare setting.
Volunteering, on the other hand, is when you provide unpaid help in a given setting. Sometimes the same setting may allow for both clinical observation experiences, as well as some volunteer opportunities. The best such experience would involve basic patient care or assisting opportunities. Anytime you undertake clinical observation, we encourage you to ask if there is anything you can do to help that would still allow you to be around the patients and the healthcare professional (for example, filing paperwork is not a particularly useful experience, but applying cold or hot packs in a PT clinic might be, since it would involve patient interaction.)
"Direct patient care" (most applicable to pre-physician assistant students) is also exactly what it sounds like: whether in a paid or voluntary capacity, you are literally providing patient healthcare of some kind. Pre-PA students, read the section pertaining to patient care on the HPPLC PA page.
Many health professions programs require that those considering the given profession undertake clinical observation prior to applying. Without exception, those programs which do not have a specific shadowing requirement nonetheless strongly recommend it. Refer to the Clinical Observation / Shadowing section of the HPPLC pre-OT, PT, or PA page for additional information, and check websites of individual programs to determine their specific requirements.
We suggest you begin to garner clinical observation experience over freshman year weekends and/or breaks if possible, and that you begin to identify and arrange well ahead of time the shadowing experiences you plan to undertake during the summer after your freshman year. Freshman summer is a great time to begin confirming whether the field you are considering is a good fit and to begin developing familiarity and comfort with the clinical setting.
We recommend you devote most of your time and effort during freshman year to acclimating yourself to college-level / IUB coursework, and to making your personal and academic transition from high school to college - learning how to study for college / IUB courses, acclimating yourself to college life and to the university in general, learning how to effectively manage your time, meeting with instructors and your advisor, and so on.
We can't stress enough the importance of establishing excellent time management and academic habits from the very beginning, as your academic performance will have a profound impact on your graduate school applications! Academics should never take a back seat to other activities, preprofessional or social. After freshman year, and once you are more certain you wish to pursue the profession you are considering, you can perhaps work additional clinical observation into your semester schedule.
Our detailed sample preprofessional timeline can give you a sense of what you should be doing right now, and also help you with your long range planning.
Clinical observation is clearly the best way for you to determine whether the daily responsibilities and the setting typical of the profession are a good fit for you, and whether you feel you have the aptitude and level of dedication necessary to develop the skills and attributes required of those who thrive and find fulfillment within the profession.
Similarly, sometimes it is through clinical observations that preprofessionals begin to form a more personal connection with the profession.
In addition, most health professions programs require some job shadowing, and these experiences can help you build your credibility with program admission committees by showing them that you have thoroughly researched the profession. Along those lines, extensive shadowing can greatly strengthen personal statements, letters of recommendation, and admission interviews.
Furthermore, most OT, PT, and PA programs require or recommend that at least one of your letters of recommendation come from a professional within the field with whom you have undertaken substantial clinical observation. While you should emphasize quality over quantity (being sure to meet minimum shadowing requirement for each program you are considering), more shadowing, especially in a variety of settings, can garner more experience from which to draw throughout the admission process.
Therefore, we strongly encourage you to arrange clinical observation fairly often, and in a variety of settings. "Variety of settings" means, for example, in-patient, out-patient, ICU, ER, family practice, hospitals, clinics, and so on - whatever pertains to your preprofessional area. That is not to say you must shadow in all settings, but simply that undertaking observation in a variety of settings is beneficial if you can reasonably arrange it. (Note that some programs will have specific requirements; for instance, a certain number of in- and out-patient observation hours. Check their websites.)
Take advantage of any connections you might have, such as family members, family friends, neighbors, or acquaintances who are members of the profession or who know someone who is in the profession. If you are pre-PA, you might also ask your family physician if he or she employs a PA with whom you could undertake clinical observation, or can refer you to any such resources. If you are pre-OT or PT, you too can ask your family physician for referrals. Physicians typically know people who work in other healthcare professions.
Each time you shadow a healthcare professional, ask if he or she can refer you to anyone else for shadowing. Networking in this manner can sometimes open the door to shadowing, service, or internship opportunities.
Use the internet
The internet is also an excellent tool for locating opportunities. For example, an internet search for "bloomington indiana physician assistants" yields useful results. One such result, www.healthline.com/doctors/physician-assistants has limited, but useful, state/city listings of PAs. If you are pre-PT or OT you can, of course, perform the same kind of search and come up with similarly useful results. If you want to locate professionals in other locations, then simply include the other location among your search terms.
How to request clinical observation
It is critically important that you conduct yourself in a thoroughly professional manner during all interactions with everyone, at all times; you represent both yourself and Indiana University. Most of our students do act in a very professional manner, yet we sometimes hear feedback from providers that students have skipped pre-arranged shadowing without notifying anyone ahead of time, cancel at the last minute, or been ill-mannered with support staff.
Remember that the professionals who allow you to shadow are not required to do so, and are essentially doing you a favor. Review the HPPLC page on professional etiquette and adopt any of the suggestions you have not already incorporated into your own conduct.
Arranging clinical observation
Some healthcare providers are very used to getting polite cold calls from students requesting clinical observation. That said, here is an alterative: You could mail, email, or hand deliver a professionally written résumé to each potential shadowing resource you have identified. Include a very brief, well-written cover letter (one or two paragraphs) in which you explain a little about yourself and your goals, including why you are interested in the profession and in undertaking clinical observation. Doing so can help you establish credibility as a serious-minded preprofessional student.
A couple of days later, you might make a follow-up phone call to see if they have received your résumé and have had time to review it for consideration. In light of HIPAA, students are finding it more challenging to find providers who are willing to allow shadowing. Polite professional persistence is your best strategy. If you have the option of utilizing summers and other breaks for shadowing in other locations, you should pursue those opportunities as well.
Click HERE for some additional ideas pertaining to résumés for prehealth students, and a link to resources that will help you draft an excellent résumé.
Additional suggestions for pre-PA students
If you are a pre-physician assistant student, you should also shadow some physicians to gain a better understanding of the differences between the two professions, how their responsibilities and duties overlap, and the different ways in which physicians supervise their PAs. PA program admission committees will sometimes ask interviewees to compare the two professions; as a practicing physician assistant, you will be working alongside physicians, so it simply makes sense for you to gain an understanding of that profession as well. And again, each time you shadow a PA or a physician, ask if he or she can refer you to anyone else for shadowing. (You might also read HPPLC's description of the two different kinds of physicians, allopathic (MD) and osteopathic (DO).
Additional suggestions for pre-OT and PT students
Consider shadowing both OTs and PTs. In some settings, OTs and PTs function very differently from each other, but in other settings they can function in similar ways. Having an understandings of these differences and similarities, and how they vary across settings, can help you better understand whichever one of the two you choose to pursue. This knowledge has the added benefit of potentially helping you during admissions interviews. It is likely you will have professional interaction with both OTs and PTs at some point in your career.
Regarding inpatient and outpatient settings: Some OT programs, and most PT programs, recommend or require that applicants have undertaken observation in both in- and outpatient settings. inpatient facilities are generally those that admit patients overnight; conversely, outpatient facilities do not have overnight patients.
The focus is on the patient
As you undertake clinical observation, remember that within the health professions the focus is on service to patients; on the caregiver-patient relationship and effective rapport-building; and on patient advocacy. As you observe, make specific note of how the person you are shadowing puts these values into action.
Be an active shadower, but also respectful of patient privacy
Be an engaged, attentive participant in your shadowing experiences. That said, it is usually more appropriate to save questions for in-between patients. Also ask whether it's okay to take notes when with patients. The answer will likely be no, in which case it's especially important to write down and reflect upon your experiences immediately after you are finished with a given clinical observation.
Do not pressure yourself to recall from memory months or years from now the details of your current clinical observations. Doing so simply creates more stress for you. You will be incorporating details and experiences from your shadowing into your personal statement. You will also draw upon the same experiences during admission interviews, and even during clinical rotations during the professional program itself. If you invest a bit of time and effort now, you will thank yourself later.
Learning from opinions about the profession
Learning from the experiences and opinions of healthcare professionals is key to your clinical observation experience, in addition to simply garnering a first-hand look at patient care.
While the opinions and perspectives of those you shadow are very important, and usually pretty well-informed, remember that the opinions and observations they express about the profession are just that: their own personal opinions and experiences. Don't be confused if you hear three different perspectives from three different healthcare professionals. Take it all in, consider all perspectives, and then form your own impressions, perhaps in consultation with a HPPLC advisor.
We further recommend that you focus on learning about the given profession itself during clinical observation rather than asking about the process of applying to or being admitted to or becoming competitive for programs. Admission requirements, preferences, and policies change often. In addition, what was pertinent to one person's application 3 or 23 years ago may not be pertinent or correct in relation to your own application or circumstances. Certainly if they offer you such advice you should thank them and make note of it, but always run it by a HPPLC advisor before acting on it.
Some questions to ask
At whatever point you have permission from the person you are shadowing to do so (oftentimes it will be in between patients or at the end of the shadowing experience) ask questions about their experience within the profession and their work routine. Your journal entries can help you assess your interest in the profession and serve as a launch pad for your personal essay when the time comes. Here are some common questions:
- What got you interested in the profession? Did you consider others?
- Do you have experience working in a different setting? (This, given that practice in these fields varies dramatically from one setting to another - in-patient, out-patient, hospital, nursing home, clinic, burn recovery, wound care, rural settings, and on and on.)
- What do you know now about the profession that you wish you'd known sooner?
- What do you like most about your profession? About your daily routine?
- Are there any aspects you enjoy less? If so, how do you rise above that?
- How many hours do you work in a typical day / week?
- How is your work time divided? What percentage is spent doing what? Examples:
- How much of your time do you spending doing paperwork?
- What other kinds of responsibilities are you expected to fulfill - committee work, community service related to the profession, others...?
- Important - network! Are you able to refer me to other practitioners within the field? In different settings? (If so, ask if you could use them as a reference when contacting their colleague and whether they happen to know of the best way to reach their colleague.)
Write in your shadowing journal immediately afterwards!
After each observation, invest 20 or 30 minutes writing about the experience, including reflecting on any responses you've gotten to the above questions.
- Assess and name the specific skills and attributes the person you shadowed exhibited - ones that you believe are important to successful practice in the profession.
- If anything troubled or confused you, write that down too, and feel free to discuss with a HPPLC advisor.
- What did you learn about the profession that you did not previously know?
- How did the experience change your impressions about some aspect of the profession?
- Did the experience help confirm that this is the profession you wish to pursue?
- If it had the opposite effect, and you are questioning your choice of profession, pay attention, this is useful information! Come talk with a HPPLC advisor. We can help you think things through and, if necessary, come up with possible alternatives.
- Important: In your journal, record in specific detail interactions you yourself had with the given healthcare professional which impacted your decision to pursue the profession or taught you something you did not previously know about the given profession.
- Important: Similarly, record specific details relating specific interactions the OT, PT, or PA had with one of their patients which impacted your decision to pursue the profession, or which expanded your understanding of the profession.
- Always keep the patient anonymous, of course - you can give them fictional names in your journal if that helps - and adhere to patient privacy protocols.
- This small investment of time and effort pays off when you write your personal essay or undergo admission interviews, and are able to be very specific, providing admission committees with compelling narratives: "During one experience here is exactly what I saw, and here is exactly how that particular experience reinforced my understanding of the profession / my decision to pursue the field." This level of specificity can greatly enhance a personal statement or interview. Vagueness and over-generalization are the enemies of a strong application. Keeping a detailed journal is one way to avoid these pitfalls.
Record your hours
Different programs have different reporting requirements
Different programs require that observation hours be reported in different ways. Some have their own required printable forms, some don't; some require application through a central application services (CAS), which will have its own reporting process, and some don't; some actually require both. You will need to confirm procedures with each program to which you plan to apply. Always check the web first, and then contact them if you need clarification.
In the meantime, especially prior to when you know exactly where you plan to apply, you need a way to record hours so that you can later report this information in whichever ways your pogroms prefer or require, whether they use a CAS or not.
Record hours for all related experiences, be they paid or voluntary, formal internships, or simply observation hours you arranged. If you know for certain that a given program you plan to apply to does require a specific form, print some copies and have them with you when you are shadowing.
Keep a log of your observation experience in a notebook or on a laptop and include the following information:
- Name and street address of the setting.
- Type of setting (including whether it was in-patient or out-patient, critical care, wound care, Alzheimer's, etc.).
- Name and title of the person with whom you spent time.
- Their contact information, including their email address, if possible.
- Their credential or license number, if it's convenient for them to provide it.
- Date and number of hours you spent with them.
- Whether it's a a paid job, an internship, or simply observation hours you arranged.
- You could also ask them to sign the entry in case a given program requires more formal reporting of hours. In this case, you might want to keep your log in a notebook. Alternatively, you could ask if their office would be willing to put your observation hours, the date, etc. in a brief note on office letterhead, along with the signature of the person you shadowed. The latter can be helpful if the person with whom you spent time is no longer there when it comes time for you to apply.
- If you happen to know you are applying to a particular program that does have its own form, print it, fill it out after shadowing, and ask the person you shadowed to sign it, if required. File it away until you turn in your application.
- Applications through a CAS such as OTCAS, PTCAS, and CASPA, have a section where you formally report your hours. In this case, you will enter the information you kept in your log, but each CAS will have its own particular way in which hours must be reported. Consult CAS FAQs and application instructions, and follow directions closely.
- Pre-PT students: closely follow the PTCS directions for verifying and reporting your observation hours. Some programs require hours to be confirmed through PTCAS, and others do not. For those that do, verification does not happen until the summer you apply. Prior to that, record hours as described above. You may or may not need to report hours separately to individual programs, as we've indicated above.
- Pre-PA students: the CASPA FAQ, "Work and Volunteer Experience," includes information about reporting observation hours. You will report hours through CAPSA, and may or may not need to report them separately to individual programs, as we've indicated above.
- Pre-OT students: the OTCAS instructions have important information about the details you should include when you report your hours; for example, if possible, the OT's license number and the state in which they received their license; the specific type of OT setting, e.g., children and youth, mental health, etc. Consult OTCAS > Instructions > Additional Information. You may or may not need to report hours separately to individual programs, as we've indicated above.
- As noted already, not every program uses a CAS, and even some that do may still require you to report hours directly to the program itself using their own forms (for instance, as part of a secondary or supplemental application in addition to the central application service process). In these instances, if you have kept a careful record of your clinical observation experiences as described above, you will be able to use it to fill out subsequent forms.
- Note: you might then still need the given professional whom you shadowed to sign the program's form (usually printed from their website). If you have gotten the professional's signature in your log next to the listings of the hours you spent with them, it will save you time and effort if you need to ask them later to sign a formal observation or volunteering form for a given program.
This information was prepared for Indiana University Bloomington students by the Health Professions and Prelaw Center. Please note that specific requirements and policies can change at any time without notice. Students are responsible for obtaining the most current information directly from application and testing services, and the schools and programs in which they have an interest. Refer to each program's web pages, bulletins, and other publications for the most current information. Students are responsible for understanding degree course requirements, as well as other requirements, policies, and procedures related to the degree(s) they are pursuing; for enrolling in appropriate courses; for understanding IU policies/procedures; and for following through properly with regard to all of the preceding.