Observation Hours: Getting the Most From Shadowing a Clinician

Most students who want to work in chiropractic, physiotherapy, athletic therapy or kinesiology will spend time shadowing a clinician before they're accepted into a program, and more time observing during it. The hours are often a requirement. Whether they're useful is up to you.

We host students regularly, and the difference between a student who leaves with something and one who leaves with a signature on a form is rarely about intelligence. It's about what they came in planning to notice.

Before you arrive

A little preparation changes the whole experience. Learn what kind of clinic you're walking into. A rehab-first sports clinic, a high-volume adjusting practice, and a hospital outpatient department will show you very different things, and all of them are worth seeing precisely because they differ. Knowing the model in advance lets you ask better questions about why things are done the way they are.

Review the basics you'll see most often. If the clinic sees a lot of low back pain, spend an evening on the anatomy and the main clinical guidelines. You don't need to be an expert; you need enough background that the vocabulary isn't noise. Most of the learning in observation happens when you can connect what you see to something you already half-understand.

Finally, be clear about the practical details: dress, arrival time, how patient consent for observers works, and what you can and cannot do. Confidentiality is absolute. Nothing you see or hear about a patient leaves the room, including in anonymized form on social media.

What to watch, beyond the hands

New observers tend to fixate on technique. What adjustment was that? How did they do that release? Technique is the most visible part of a visit and, in many ways, the least important. Research on clinical expertise has been consistent for decades on this point: what separates experienced clinicians from novices is not a larger toolkit but how they organize information and reason through it.¹

So watch the reasoning. A few things to track in every visit:

• The history. What questions did the clinician ask, and in what order? Which answers changed the direction of the conversation? Which questions seemed unrelated to the complaint, and why might they matter?
• The examination. What was tested and, just as important, what was skipped? Experienced clinicians test to confirm or rule out specific ideas, not to run every test they know.
• The explanation. How did the clinician describe the problem to the patient? Listen for plain language, for how uncertainty was handled, and for whether the explanation made the patient more confident or more worried.
• The plan. What was the patient asked to do between visits? How much of the visit was hands-on care, and how much was teaching? What was the stated goal, and how will anyone know if it's being reached?

Our post on moving from student to clinician thinking covers this transition in more depth, but the short version is that the history and the plan are where the real work happens. If you watch only the middle, you miss it.

Ask questions, at the right time

Most clinicians enjoy teaching and will happily explain their reasoning, but not in front of a patient who is mid-sentence. Keep a running list during the visit and ask between patients or at the end of the day. Good questions sound like "You asked about her sleep before you asked about the knee; what were you looking for?" rather than "What's the best treatment for knee pain?"

It's also worth asking how the clinician decides what evidence to trust. Evidence-based practice, as originally defined, means integrating the best available research with clinical experience and the patient's own values and circumstances.² Watching how a working clinician balances those three things, especially when the research is thin or the patient wants something the research doesn't support, is one of the most valuable things you can observe.

Turn hours into learning

Observation is passive by nature, and passive exposure doesn't build skill. The research on expertise is clear that improvement comes from focused effort on specific aspects of performance with feedback, not from accumulating time.³ You can build that into shadowing with a few habits.

Write a short note at the end of each day: two or three cases, what you thought the diagnosis was before the clinician said it, and where you were wrong. Over several shifts, patterns in your own errors become obvious, and that's where you focus your studying. If the clinician is willing, tell them your working impression before they share theirs, and ask them to correct it.

Pay attention to the whole operation, too. Watch how the front desk handles a late patient, how documentation gets done, how a referral to a physician is written. Clinical practice is a system, and the parts you're not yet trained in are the ones that surprise new graduates most. At a clinic like ours, the range of services and conditions seen in a given week is wide, and much of what students learn is how one clinician moves between them with a consistent way of thinking.

Choose where you shadow deliberately. If you can, see more than one model of practice, and try to spend enough time in one place that you see patients return. Watching a plan unfold over four visits teaches more than four single visits ever will. We've written about how to choose a mentor or preceptor, and the same criteria apply when you're deciding where to spend observation hours.

The hours will get signed regardless. What you do with them is the part that follows you into practice.

References

1. Norman G. Research in clinical reasoning: past history and current trends. Med Educ. 2005;39(4):418-427.
2. Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn't. BMJ. 1996;312(7023):71-72.
3. Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev. 1993;100(3):363-406.