Introducing Shadow Housemanship in Medical Training: Pros and Cons
Year: 2024
Type: article
Abstract: INTRODUCTION Medical graduates on the completion of their training become part of the health workforce and are expected to discharge a wide range of duties and responsibilities.[1] Shadow housemanship is a specific type of training imparted to medical students, wherein they observe and follow experienced doctors, with reference to how they approach and carry out their daily duties in a hospital or clinical setting.[1,2] This training is generally offered to medical students on the completion of their undergraduate training but before the commencement of the internship program. Shadow housemanship is preferably offered in all major clinical departments for a stipulated period and such kind of exposure in different clinical departments enables and empowers students to pursue the postgraduation course of their choice. This initiative ensures that medical students get firsthand exposure to the practical aspects of medical practice and also learn the art of administrative tasks associated with being a doctor.[3] In the process, experienced doctors act as mentors and provide guidance, respond to queries, and share their wealth of knowledge, skills, and experience with the shadowing medical students.[2-4] At the same time, students experience the real-world hospital and understand the workflow and challenges encountered by health-care professionals.[1] TRADITIONAL VERSUS SHADOW HOUSEMANSHIP Housemanship is an integral and indispensable component of medical undergraduate training and carries paramount importance in improving the competence of students. In traditional housemanship, the focus is toward the active involvement of students in patient care through asking them to perform clinical duties, while shadow housemanship advocates observation and learning by watching experienced and senior doctors.[5] In terms of responsibility assigned to students, traditional one gives significant onus to the students in direct patient care, including diagnosis and treatment, while shadow housemanship either gives nil or limited responsibility on students in patient care.[2] In continuation, students get extensive hands-on experience in patient management and clinical procedures, while the hands-on experience remains extremely less in shadow housemanship.[1] With reference to supervision, in traditional housemanship, the clinical tasks are monitored by teachers, but in shadow housemanship, there is more of mentoring.[1,2] The overall duration of housemanship varies from one nation to different and is generally 1–2 years (traditional) or few weeks to months (shadow). As expected, the extent of workload and stress levels remains quite low among students pursuing shadow housemanship, while it is too high among medical students pursuing traditional housemanship.[2] The evaluation of traditional housemanship is done by assessing the performance of students periodically and by providing feedback to students in the domain of clinical skills, patient care, and professionalism. On the contrary, the evaluation of shadow housemanship is accomplished by obtaining feedback from students on their understanding and observational learning during the period.[4] BENEFITS OF SHADOW HOUSEMANSHIP Shadow housemanship has been linked with multiple benefits to students, starting with providing a firsthand experience in clinical settings, thereby bridging the existing gap between theoretical knowledge and practical application.[6] This exposure helps the student to understand various roles and duties of health-care professionals, including augmentation of their clinical reasoning and decision-making skills through observation and discussion of different real cases.[1] In continuation, students also become familiar with the functioning of health-care facilities and the significance of the interdisciplinary nature of patient care.[6,7] As students become familiar with the hospital environment and also observe patient interactions in the absence of pressure/direct responsibility, they tend to have higher confidence levels and reduction in anxiety.[5] Further, this exposure is extremely crucial for the development of professional behavior and the improvement of soft skills (such as communication skills, teamwork, empathy, and compassion) through observation of experienced doctors.[8] Shadow housemanship is also crucial for making medical students understand the importance of medical ethics, informed consent, and confidentiality by exposing them to ethical dilemmas and real-world case scenarios.[1,5] Students also realize the need and ways in which patient-centered care can be implemented in medical practice, which will also play a vital role in the empowerment and active involvement of patients.[5,9] Medical students also learn the art of time management and prioritization of their duties, especially in busy workplace settings. From a career perspective, students get exposure to different specialties and thereby get enough information to decide their future career path.[10] In fact, students get an opportunity to develop connections with medical professionals (networking) which can prove to be useful for their future careers.[10] Further, it also prepares students for their residency by providing them with a preview of the clinical environment. Finally, students also realize the scope of integrating research activities into patient care and thereby contribute toward practicing evidence-based medicine.[1,5] Even though shadow housemanship is not an immediate possibility in Indian settings, nevertheless considering the associated merits and the very fact that there are multiple educational reforms happening and have happened in the past few years, including the introduction of CBME, we need not think that it will never be introduced in India. With the passage of time and newer developments, this training can very well become a part of the medical curriculum offered in India. POTENTIAL CONSTRAINTS Shadow housemanship has its share of criticism and potential challenges that must be given due recognition to ensure that attributed benefits can be optimized. As the program is still finding its feet in different institutions, there is a lack of standardization and a wide variability in the way it is being implemented, which in turn results in inconsistent learning experiences.[2] As the primary task of students is to just observe rather than perform directly, it can significantly impact the acquisition of practical or clinical skills.[1] Moreover, as students are just passive learners, it will not be incorrect to state that their extent of learning can be limited.[5] From the patient’s perspective, concerns related to obtaining consent from the patient and maintaining confidentiality can emerge as one of the important ethical and legal issues. We must acknowledge that the success of this initiative essentially depends on the quality of mentorship, which can vary widely and there is a definite possibility that it may not meet the needs of students. This can be in the form of poor or limited feedback provided to students by mentors on their observation and learning, which eventually limits the ability of students to improve and refine their skills.[3] From the administrative perspective, the presence of shadowing students might influence the workflow of patients and can even impact the quality of care.[2] In continuation, there can be concerns regarding the allocation of sufficient resources, including mentors for the smooth implementation of the program. The need of the hour is to understand all these concerns and then adopt specific targeted measures to enable smooth integration of this initiative into the medical curriculum and thereby effectively contribute to medical training.[9] INTEGRATION OF SHADOW HOUSEMANSHIP WITH MEDICAL CURRICULUM As mentioned earlier, the integration of shadow housemanship into the medical curriculum is expected to bridge the existing gap between theoretical knowledge and practical experience.[2] However, the integration process must be carried out in a structured manner, which is well supported by the faculty development program and sensitization of students to make them realize the scope, significance, and associated merits of the initiative.[2,3] Specific learning objectives and learning outcomes of the initiative must be defined and accordingly, learning activities should be planned to support the process of attainment of the intended learning objectives. Moreover, all these planning of teaching-learning activities should be in alignment with the overall medical curriculum, as this will make the learning process more engaging and relevant for the students. Finally, it is equally important to plan for the evaluation of the entire initiative and based on the obtained results, introduce modifications to benefit students and make the program more effective. CONCLUSION Shadow housemanship plays a vital role in promoting a seamless transition from academic learning to clinical practice and thereby empowering them for residency and independent practice. The need of the hour is to explore the possibility of its introduction into the medical curriculum and systematically integrate it with traditional housemanship to optimize the benefits of both forms of training for medical students. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Language: English
Field: Medicine
Domain: Health Sciences
SDG: Quality education
Open Access status: diamond
OpenAlex ID: W4403559956