blogs

Pre-Shadowing Preparation

Shadowing a doctor can be a very useful opportunity for anyone who’s interested in pursuing the medical field. However, there’s a lot of preparation to be worked through before one can successfully partake in a shadowing experience.

For my senior project, I knew I wanted to get some rich first-hand exposure to medicine, but I was still unsure of the one specialist I wanted to focus on so I ended up reaching out to doctors across different specialists in order to get a more diverse and dynamic shadowing experience.

During the early spring I was able to connect with three different doctors: Dr. Gardner, Dr. Robinson, and Dr. Bacu.

Each of these doctors work at different hospitals so I needed to get in touch with each doctor’s assistant or hospital administration to find the requirements and forms needed to shadow at each place.

The process to shadow Dr. Gardner was one of the most thorough, as I had to sign various forms that stated I would follow UPMC’s confidentiality guidelines to protect all patient information I would be exposed to when shadowing a physician. After sending out all of these forms, I was also asked for a TB test and proof of COVID vaccination, since of course we are still in a pandemic. UPMC also even had me send a copy of my healthcare insurance card. When all of these documents had been received, I was sent a Zoom link to attend a mandatory half-hour orientation where they explained the guidelines to shadow, what to not do in front of a patient, dress code, and more. After all of this had been completed, I was finally cleared to shadow Dr. Gardner.

To shadow Dr. Robinson, the clearance process in AHN was a bit quicker. I had to complete a survey shadowing request through their page which still required the TB test, but no additional forms. I did however, have to get in touch with Dr. Robinson first before filling out this request since it also asked for an email confirmation of the physician attesting for the dates. Prior communication with the physicians was always important as they would also be my point of contact if I had any questions at any point during this process.

Finally, to shadow at the Armstrong County Memorial Hospital with Dr. Bacu I had to repeat the whole clearance process again. And even though the forms might have taken some time to fill out and communicate with the staff, I was grateful I got the forms out of the way at least a couple of days before senior projects began so I could schedule all of the three doctors’ shadowing dates without overlap.

Besides having the approval to shadow at each different hospital, I also wanted to prepare myself by doing some research on each of the physician’s specialties before the date of shadowing. Though I wasn’t sure exactly what I would be seeing each day, doing some initial research on what a neonatologist or rheumatologist focused on would be useful for some background knowledge to have.

To see the information I found on each specialist, visit each doctor’s bio page.

I should also mention that due to the confidentiality forms I had to sign, I was not able to take any pictures inside the Operating Room or disclose personal information about any patient when talking about my shadowing experience.

Day 1: Shadowing Dr. Gardner (5.9.22)

Today was my first day of shadowing and I have to say I was both anxious to get started, and a little nervous about what I would face during my time shadowing a neurosurgeon. My day began at the Presbytarian UPMC Hospital in Oakland at 8:40am. Upon my arrival, I was supposed to meet Dr. Gardner’s assistant in the neurology department, but Presby is a big hospital so although I got a little lost, I was able to find my way into the right place. Dr. Gardner’s assistant then led me to the Operating Rooms Wing where we waited a couple of minutes until Dr. Gardner could receive me since he had already begun the initial part of the surgery.

I observed two surgeries that day. The first one at Presby was a surgery to treat carotid artery disease called a carotid endarterectomy (CEA for short). This procedure is done to remove fat and cholesterol (plaque) buildup from inside the carotid artery to improve blood flow to your brain. The surgery helps prevent strokes for anyone who’s either already had one, or at risk for one from carotid artery disease. A stroke occurs when not enough blood is able to reach the brain, thus, when blood flow inside your carotid arteries slows down or stops due to the plaque buildup, this presents a blood supply complication. Humans have two carotid arteries on either side of the neck, but the procedure I observed today only operated in the right carotid artery. I was shocked at the amount of plaque Dr. Gardner was able to remove, as it was so compact that it almost looked like bone. Luckly, he seemed to be able to get all the buildup out of his artery and he left the closing up of the patient to the medical student who was assisting Dr. Gardner in this surgery.

I did not observe the surgery all the way to the end because Dr. Gardner had to be at Children’s Hospital at 10:00AM, so we quickly transported there to get in time for the next surgery.

This next surgery was a very unique procedure that I had never even heard of, and as I later learned, was also not performed often. It was an invasive procedure where the child patient had to have its left eye and orbital bone removed because he had a background of a myosarcoma tumor. This surgery incorporated three major surgeons––each who specialized in different parts of the surgery that were done. There was a doctor present who is a specialist in ophthalmology and was the one who did the entire eye removal procedure. There was also another surgeon who was a specialist in otolaryngology and cranial base surgery, and last but not least, there was a surgeon who performed the cranial catheter portion of the surgery. Not only were there four major surgeons in the room, there were also 5 residents present and a fellow as well. For a surgery to go smoothly, there will also be a surgical technician required during the entire procedure as they are the ones handling every instrument and equipment that the surgeon needs. Without the surgery technicians, no surgery would be possible as they actually play a critical role when assisting the surgeons and are needed before, during, and after the entire procedure.

I left that day when the main aspect of the surgery was done and the doctors were beginning to close up the brain. I had been in that room for almost 6 hours and my feet were pretty sore from standing all that time, yet most people in the OR would probably be there for about another 2 hours. Tired but super inspired, I think my first day of shadowing was a big success.

Day 2: Shadowing Dr. Robinson (5.10.22)

I shadowed Dr. Robinson for the first time today. It was a bit of an earlier wake-up time for me this time as I had to arrive by 8:25AM, but I was proud I was able to find my way through the West Penn Hospital and report to the Newborn Intensive Care Unit (NICU) where I met up with Dr. Robinson. As soon as I arrived, Dr. Robinson brought me in with her to a room where her fellow colleagues, residents, and some medical students gathered in a circle to discuss last night’s events. This discussion was led by one of the neonatal physicians who had had the night shift and it was done each morning to bring the incoming doctors up to date about the status of each baby at the NICU. The neonatologist informed the group about any major trauma with any of the babies, new patients that had arrived during the night, and revisited the planned discharged patients for the day. In the midst of this summary though, Dr. Robinson turned towards me and asked me if I wanted to see a baby being delivered right then. She had just been paged about it so we quickly left the room and rushed over to the mom’s room where we got just in time to see a small baby girl take its first breath in this world. I had never seen a baby being delivered and it was such an exciting start of the day to just see the miracle of life right before me. I also had never realized how many people were involved in the delivery of a baby, but as I looked around I noticed clearly how there were two split groups in the room. One group was gathered around the mom helping her with pushing out the baby and making sure she was also well throughout the entire process. The other group took care of the baby as soon as it was out of the mom’s womb and helped clean it, weigh it, dress it, and perform a couple of small tests to make sure the baby had been born healthy.

Day 3: Shadowing Dr. Bacu (5.19.22)

I shadowed at Armstrong County Memorial Hospital today. It was my first time meeting Dr. Bacu and I had been told by her very nice assistant Nicole, that today Dr. Bacu would be in the clinic seeing all her scheduled patients. Dr. Bacu and I quickly got started on her consults as she had 11 patients that she was supposed to see throughout the morning and afternoon. I was not very sure at the beginning how the whole clinic thing went, but I got the hang of it pretty easily as Dr. Bacu’s efficiency kept me at a fast pace. For each patient, before even entering their room Dr. Bacu would review the patient’s profile and account, study the most important aspects of their health, and finally then go into the consultory. During the appointment Dr. Bacu would ask some rutinary questions at the beginning of each visit such as : How long are you stiff in the morning (in hands and feet) ? Any areas of swelling ? What areas are painful right now?

She would also after talking with the patient about their symptoms, do a body examination of the joints to test where the patient was most tender. Being a rheumatologist, Dr. Bacu treated a lot of osteoarthritis and rheumatoid arthritis which were probably the most common diseases that we saw in the patients that day and generally overall too.

I expected to go into that day prepared to see only older adults who’s symptoms would be highly associated with their age and bone density wear, however, there were a couple of cases with some younger women and men who were less than 30 years old and had some type of arthritis disease.

Day 4: Shadowing Dr. Robinson (5.20.22)

I shadowed Dr. Robinson for the second time today in the NICU. Our day together began early at 8:25AM with a quick meeting to discuss again the last night's events that had occurred in the NICU. There were 33 baby patients and no babies were on schedules to be discharged, so the NICU was pretty busy today. After the daily discussion, I was able to rush into the room of a newborn who the doctors had to operate to insert a utero catheter for feeding purposes since it was so small and was not developed enough yet for normal breast or bottle feeding. Dr. Robinson did not have any consults today so I went to do rounds with one of the two teams and thus was able to see various cases of the baby patients there. Throughout rounds I also learned about the car seat test that all babies had to pass in order to be eligible for discharge. And just like it sounds, the car seat test is an exam where they put the baby in a car seat for about 90-120 minutes as they monitor its levels (oxygen, blood pressure, temperature). If the baby does not pass the test, meaning it presents complications with any levels that the nurses monitor, the baby will need to stay in the NICU for another day until it is able to pass the test. This is something that I found so interesting because I had never really thought about how fragile a preemie can be to the extent where they have to make sure it can be in a car seat without having issues before they allow the baby to be sent home (hence the car ride home issue).

filtered-3FF0102E-1083-4A4C-98F1-5C92955E8370.mp4

Day 5: Shadowing Dr. Gardner (5.23.22)

We are back in the OR today at Presbyterian shadowing neurosurgeon Dr. Gardner! Today I was very shocked to observe the extent of a cranial surgery, whether it was an open surgery or less invasive surgery, yet they all required hours of precision and detail. It was also very impressive to see the ease of how Dr. Gardner would switch between surgery rooms and operate the different procedures with a skill in multitasking. The first two surgeries I observed, an aneurysm and right suboccipital tumor surgery, were occurring simultaneously. I would try to pop in each room frequently although I ended up watching more closely the craniotomy aneurysm clipping surgery. During the surgery I was fortunately accompanied by a medical student who was doing his clinical rounds and also talked me through some of the steps of the procedure, but was also very useful in answering my lingering questions about steps or instruments that were used throughout. I was also told by the staff there at Presby that various aneurysm surgeries were done here because of Dr. Gardner’s specialty focus and training so it was pretty cool to be present with one of the best surgeons for this kind of procedure. Once the surgical team had opened the skull and located the aneurysm, Dr. Gardner clipped the neck of the aneurysm with a small permanent metal clip. Although this sounds fairly easy, this process can be extremely difficult as the surgeon must make sure that the clip is only placed in the aneurysm and not any of the other vessels that closely surround the aneurysm. To check that the placement of the clip had been done correctly and the aneurysm is fully sealed off, technicians came into the OR to do a cerebral angiogram. During the procedure of a cerebral angiogram, a thin and flexible tube is inserted into a large artery in the groin and passed through the heart and up to the brain. Once in the location of the aneurysm, the technician injected a special dye into the blood vessels as a way to produce instant x-ray pictures of the inside of blood vessels. With these images, the doctors were able to determine that the aneurysm had been clipped off fully since they saw no dye flow in that region. I was able to see the whole process of closing up the brain up until they woke the patient up when they discontinued anesthesia. I enjoyed seeing the closing procedure of the surgery as well as there was so much interaction from all different types of people to make this happen.

Day 6: Shadowing Dr. Gardner (5.24.22)

I got to do a clinic day with Dr. Gardner today! It was an earlier start to our day as I had to arrive at Presby by 7:45AM. I’ve learned that clinic days are spent between visiting the patient’s rooms and the doctor’s office or workroom. When I arrived at this clinic, the physician assistants were already in the workroom writing patient’s information and background from the previous doctor’s visit into their online charts. Talking with one of the physician assistants, I was informed that today, Dr. Gardner hasd 51 patients scheduled for an appointment. I was immediately shocked because that seemed like a lot of people to see in one day. And to make matters a bit more complicated, the online video visits were not working due to a technician difficulty from the video platform. Nevertheless, Dr. Gardner seemed like this was routinary work as he worked with his team productively to get every patient checked out in an efficient manner. I was able to listen to the patient’s summary that his team gave to Dr. Gardner before seeing any patient, go into the patient’s room and listen in during the actual appointment, and then hear Dr. Gardner’s concluding remarks and debrief after the check-up. I saw all kinds of patients from very young ones who were having a follow-up with Dr. Gardner about a surgery they had just had recently, to some older ones who were unfortunately given news that a cerebral tumor had come back after years of nothing. I learned how common yet difficult having cushing’s disease was from two patients that day who had had a large excess of the steroid hormone cortisol in the blood level caused by a pituitary tumor secreting adrenocorticotropic hormone ACTH. This disease had made them gain weight uncontrollably and presented with a lot of muscle weakness along with other symptoms caused by the tumor. For one of those patients, the only solution to get rid of the symptoms and lower the cortisol level was for them to have a surgery where they would remove the two tumors of this patient through the nose. Another very interesting case that I was able to see today was a patient who had come in because they had just had a shunt malfunction recently. Shunts are hollow tubes that are placed in the brain to help drain cerebrospinal fluid and redirect it to another part of the body where it can be reabsorbed. A shunt placement surgery is done on those people suffering from hydrocephalus which is a condition where there is an abnormal buildup of fluid in the ventricles deep within the brain. This excess of fluid in the brain causes the ventricles to widen, and puts a lot of pressure on the brain’s tissues. The shunt helps drain this excess fluid and prevent pressure from getting too high in the brain.

Although shunt malfunctions are actually more common than I thought with 48% of them having the possibility of needing a shunt revision, what was great about this case was that the patient had gone into the ER to get checked out before the shunt malfunction had severely affected him. Usually, patients with shunt malfunctions don’t notice until high levels of fluid have accumulated in the brain and the pressure is too high risking cerebral damage, however, this patient had lucky gotten checked out almost right away and did not suffer any brain damage.

Day 7: Shadowing Dr. Gardner (5.26.22)

Dr. Gardner had two surgeries today one which was a left crani acoustic neuroma, and the other a endoscopic endonasal approach (EEA) surgery. The first surgery was done by a bicoronal craniotomy for resection of left gleams which means that after drilling some holes and removing part of the skull, the surgeons carefully dissected the dura from the internal table of the skull. I was able to see the ear canal very closely as well as see the surgeons so carefully use stimulation to make sure that no brain damage would occur and map out the main vessels in which they should be careful when cutting. Once the procedure is complete and the tumor has been removed as best as possible, the tissue that has been cut is stitched together and the bone flap is reattached using some metal plates.

The EEA surgery was very long. I only got to see about 5 hours of it but removing the tumor from the brain through the nose took a lengthy amount of time and precision that made this surgery last for about 8 hours.

Day 8: Shadowing Dr. Gardner (5.27.22)

Last day of shadowing! I headed to Presbyterian and got into my bunny suit one last time before walking into OR. Today I observed another EEA surgery, yet this time the tumor was in the pituitary gland so it would be faster to remove it through the nose. In another room, a left sided crani for a tumor was also being performed, so I switched observing between these two surgeries. Today I also learned all about the circulating nurse’s role in advocating for the patient while they were asleep, and maintaining a sterile environment that is critical for the patient’s health. A circulating nurse will also position the patient appropriately after discussing with the main surgeon about the best possible position for operating that patient, and they will also manage the room which means they will be the ones responsible for accounting all instruments used throughout. They also cover some tables with blue cloths and mantles to create their sterile environment which means only those who are scrubbed in are able to touch any instruments that are placed in those tables. Each new instrument that the surgeon calls for that is not already in the sterile tables is brought by the circulating nurse and unwrapped in a manner in which they do not touch the actual instrument, but just hand it to the surgical technologist. This job requires special concentration and skills, and they are present during the entire procedure up until the patient has woken up and is ready to be taken out of the OR. Although I’ve learned so much from shadowing these different types of doctors, in every situation I’ve also had the chance to learn about all of the other people who work so closely with these doctors, and who without them, the high success of patient care would not be possible. This has truly been a memorable experience, but also a very eye-opening experience as I leave my senior project with maybe more questions to be answered than those before I began. But, I think that was the goal. To go out and delve into the big, complicated, and exciting field of medicine that is always growing, changing, and working towards a better future for people’s health

Importance of Teamwork and Interdisciplinary Efforts in the Medical Field

As mentioned earlier, if there’s one thing I’ve learned these past three weeks is that teamwork in every practice is essential for the success of healthcare for every patient. Though I shadowed very specific doctors, I really got the chance to see more than just their discipline but how their specialty intersected with so many other different fields in order to provide the best care.

In the OR, there will be at least a surgical technician present, a CRNA/RES which is certified registered nurse anesthetist, neuro physician, head perioperative nurse, image guidance technician, and maybe a fellow or med school student. The head nurses are in charge of making sure all supplies are accounted for during and after the procedure. To make sure nothing has been left inside the patient, they count every cloth used in the end and compare it to the number of cloths they supplied to make sure they have collected all of them before leaving the patient. They also have this “magic wand” which is a while halo circle that the nurse waves over the patient to look for signs of cloths left inside since the cloths have a metal strip that can be detected with the wand. The image guidance instrumentation is used to improve accuracy in the surgeon’s entry and target and decrease liability in case something were to go wrong during the surgery. The image technician will also be there to set up the different settings to match the surgeon’s need of checking the dura mater layer of the brain or target in respects of another base point.

Page updated

Report abuse