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Current PAs: Tips on how to be a great observer/shadower?

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What follows was developed for PA students going through their clinical rotations. Clearly you won't be wearing scrubs, or a white coat,  or carrying a stethoscope, or helping the preceptor with procedures: you're there to watch and learn. Most of the rest of it is valid for shadowing.

Rotations for Newbies


Preparing for Rotations




1. Decide that you are on the ultimate “field trip” with the goal of learning all you can about what life is like for a PA in whatever rotation you are on.


2. Even though you aren’t being paid, consider it a job, and one that you would like to keep! (You might actually get a job offer too).


3. These people may play a role in your life later, even if you don’t want to work for them. For example, one day I found my preceptor preparing a recommendation for a student in the class ahead of ours.




1. Buy the second white coat so you always have a clean, IRONED coat ready to go. Patients may have more respect for you if you look like you made an effort.


2. Consider getting a smartphone with the paid version of Epocrates (Essentials Sx/Dx) on it. Best single piece of personal equipment (next to a pen and a stethoscope).


3. Like all disciplines, medicine involves a lot of abbreviations. Consider Beiks Bdicty on your phone  (www.beiks.com) with the “MediAcro” option.  This lets you look up abbreviations (especially in the hospital, which is the home of abbreviations!) without bothering asking even more questions than you need to.  It costs about $25 and lets you know, for example, that your cardiologist’s cryptic remark to his nurse about a “PFO” involves a patent foramen ovale.


4. I’d carry the Tarascon Pocket Pharmacopoeia ($10 from www.tarascon.com).  It lets you quickly look up drug doses, fits in your scrubs, and you won’t cry quite so hard if you lose it (like you would for a lost or broken PDA).  It will help you when your preceptor says to write a script for him or her. It also has the advantage of showing drugs by family, which is great when you want to see a list of second-generation cephalosporins or anti-emetics to consider.


5. Maxwell’s little book of documentation formats the program issues is a great reference.


6. Carry a pen and 3x5 cards to write down patient ages etc for tracking, as well as your preceptors pearls of wisdom, or messages you get when you call back doctors that have paged him.




1. Try to go to every site some time other than the first day you are due to work. Dress up as if you are on a job interview; I never wore a white coat that day to emphasize that I wasn’t yet working for them. 


2. Ask about things you can do to prepare. The preceptors often gave me references to read (sometimes they even gave me the books too). 


3. This early trip makes things easier on the first day and also set up a good first impression. It also gives you a chance to meet the staff and SEE HOW THE PHYSICIAN DRESSES.


The Rotation


1. Look the part and dress at least as well as your physician does (some of them may not exactly be good fashion models!). Depending on the rotation, that might mean scrubs or it might mean a dress shirt and tie.


2. The preceptors don’t get paid to have you around, so try to send the message that you are interested in the subject matter and will do anything you can to be helpful. Consider it a success if they actually start depending on you to save them some time.


3. If someone says “Would you like to (see a case, see a patient on your own, try a procedure that you have at least seen done once)…”, say “Yes!” If you want someone standing by because you are afraid you might hurt the patient, don’t hesitate to tell your preceptor that as well.


4. If you’re trailing your preceptor around, pretend that you are shooting a documentary on what his life is like (talking to patients, doing procedures, talking to family members, interacting with staff, dictating, filling out paperwork, or whatever.). At any moment, he may start telling you to do something that you could have been watching or listening to him do. 


5. Ask questions, but be sensitive as to when is the best time to do it.


6. Establish relationships with the preceptor and his or her office staff. Get to know each other and try to learn from everyone.


7. Be gracious and thank everyone who helps you. This includes the nurse who will invariably save your butt the first time you try to suture a child in the ER or scrub-in in the OR.


8. You will often come home too tired to crack a book. Make a list of things you didn’t know or need to know more about. Spend some time on the weekends reading up on them.


9. People (including patients) will be interested in who you are and why you are becoming a PA. Have an answer ready!


10. Enjoy the patients. They will teach you a lot and they know more about what’s wrong with them than they know. Often you will be the only person who has the time to listen to them.


After the Rotation


Send a thank-you card to your preceptor. Also to any of the staff who were particularly helpful, and one to the staff as a whole. They did a lot for your education, so show some gratitude.

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All of the above is good advice - I just want to speak up about one thing:  arrangements.  This is HIGHLY dependent on your program and site.  We had a process for contacting our future preceptors at least 2 weeks out and asking those questions (required attire, anything we can do to prepare, etc) and I personally favor making the commute once to see how to get there and be familiar with where to park, but it would absolutely have been frowned upon for us to make a visit prior to our first day.  I can't think of a single rotation I had where a pre-emptive visit would have been welcomed (and also, I was on other rotations and frankly did not have the ability to do this).

As far as shadowing:  come prepared, well dressed, and have questions ready but it is almost always going to be best to ask those questions away from the patient.  Bring a notebook to take notes but don't take those notes in front of the patient - even if it's just a question you think of not related to the visit - as a patient I would be suspicious why a shadowing student was taking notes on my visit.  Be interested and engaged and leave your phone in your bag/car/anywhere else  - you won't have any reason to be checking it during your shadowing experience.

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  • 2 months later...

I have many students that shadow me and definitely can give advice.

My tips and pet peeves:

1. Be concise and succinct with emails and pay attention to what we say. I have a pre-typed lengthy email that I copy to all my students that includes a list of all required documents, clinic addresses, available days and times to shadow etc... I get so many students that will email me the day prior to the day they shadow asking for the address or not following instructions. Students, we are busy people and if excessive emails can be avoided, it is appreciated! (This is probably because I have 30+ pre-PA students on rotation that shadow me and constantly get bombarded with emails requesting for shadowing so throughout the years I have gotten annoyed haha)

2. Be interactive but use common sense to know when it's the appropriate time to ask questions and when it's excessive. When students ask me a ton of back to back questions that require lengthy answers, it puts me behind and often times I don't get to chart, put in orders, return patient calls, etc...

3. Come prepared with questions. I have some students who literally are like a fly on the wall and that's fine but it doesn't make you memorable to me so if a student comes back later and asks me for a rec letter and I don't remember you, that's not a good thing.

4. Please dress professionally. I require my students to either wear business professional or scrubs. I've had students show up in leggings or rompers and that is not okay.

My personal opinion..

Great observer - interactive, asks follow up questions to what I am explaining/teaching, shows that they are gracious for my time
Okay observer - fly on the wall, asks very little questions, not memorable
Bad observer - comes late, not prepared with questions, seems disinterested and on their phone or constantly looking at their watch (gives me impression that you are just there for "hours" and not to learn)

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